title: Racial/Ethnic differences in B-type natriuretic peptide levels and their association with care and outcomes among patients hospitalized with heart failure: findings from Get With The Guidelines-Heart Failure.
abstract: OBJECTIVE
  This study sought to determine if there were differences in B-type natriuretic peptide (BNP) levels across racial/ethnic groups and in their association with quality of care and in-hospital outcomes among patients with heart failure (HF).
  
  
  BACKGROUND
  It remains unclear whether BNP levels and their associations with quality of care and prognosis vary by race/ethnicity among patients hospitalized with HF.
  
  
  METHODS
  Using Get With The Guidelines-Heart Failure (GWTG-HF), patient characteristics and BNP levels at admission were compared among 4 racial/ethnic populations: white, black, Hispanic, and Asian. The associations between BNP, quality of care, in-hospital mortality, and length of stay (LOS) across these groups were analyzed.
  
  
  RESULTS
  A total of 92,072 patients (65,037 white, 19,092 black, 6,747 Hispanic, and 1,196 Asian) from 264 hospitals were included. Median BNP levels were higher in Asian (1,066 pg/ml) and black (866 pg/ml) patients than in white (776 pg/ml) and Hispanic (737 pg/ml) patients, and race/ethnicity was independently associated with BNP levels (p < 0.0001). Irrespective of race/ethnicity, patients in higher BNP quartiles (Q3, Q4) were more likely to be older and male and have lower body mass index, reduced ejection fraction, and renal insufficiency, whereas those in the lowest quartile (Q1) were more likely to have diabetes. With some exceptions, there were no significant racial/ethnic differences in the association of BNP levels with performance measure adherence. In multivariate analysis, elevated BNP levels remained associated with longer LOS and increased mortality in all racial/ethnic groups.
  
  
  CONCLUSIONS
  Asian and black patients with HF had higher BNP levels at admission compared with white and Hispanic patients. BNP levels at admission provided prognostic value for in-hospital mortality and hospital LOS irrespective of race/ethnicity.
authors.affiliation: John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana. Electronic address: krimselim@hotmail.com.
authors.forename: Selim R
authors.initials: SR
authors.lastname: Krim
authors.affiliation: University of Texas Medical Branch, Galveston, Texas; Methodist DeBakey Heart and Vascular Center, Houston, Texas.
authors.forename: Rey P
authors.initials: RP
authors.lastname: Vivo
authors.affiliation: Bronx Lebanon Hospital, Bronx, New York.
authors.forename: Nassim R
authors.initials: NR
authors.lastname: Krim
authors.affiliation: University at Albany-SUNY, Rensselaer, New York.
authors.forename: Feng
authors.initials: F
authors.lastname: Qian
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Margueritte
authors.initials: M
authors.lastname: Cox
authors.affiliation: John Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana.
authors.forename: Hector
authors.initials: H
authors.lastname: Ventura
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: VA Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000628:therapy; D006630:Hispanic or Latino; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D044465:White People
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: BNP; heart failure; outcome; quality of care; race