Natriuretic peptide testing in veterans hospitalized with heart failure: Potential differences by sex

Natriuretic peptide testing (NPT) is recommended to assist in diagnosis and prognostication during heart failure hospitalization (HFH). NPT on admission for HFH and sex-based variation in NPT are unknown.

We investigated the utilization of NPT among Veterans with HFH, evaluated for sex-based differences, and examined associations with demographic, clinical, and facility characteristics.

Among Veterans with HFH in the Veterans Affairs Healthcare System between October 2015-September 2020, we assessed the rate of NPT on admission and sex-based differences in NPT. We determined associations with demographic, clinical covariates, (comorbidities, laboratory values, loop diuretic use), and facility characteristics using logistic regression.

Of 55,935 patients with HFH (women=1237 (2.2 %)), women were younger (68.3 versus 72.8 years, p < 0.001), less likely to have cardiac comorbidities, and more likely to have ejection fraction >40 %. Admission NPT occurred in 78.3 % of patients (men=78.4 %, women=74.7 %; p = 0.002). In adjusted analyses for clinical and facility-related factors, women were 15 % less likely to receive NPT compared with men [odds ratio =0.85, 95 % CI (0.75, 0.98)]. In sex-stratified models, atrial fibrillation and prior loop diuretic use were associated with increased likelihood of NPT and previous NPT was associated with decreased likelihood in both sexes. Overall associations were similar in both sexes.

Women were less likely to receive NPT during HFH compared to men, potentially risking greater delays in HF diagnosis and treatment. Further investigation should examine the impact of the absence of admission NPT on clinical outcomes and identify strategies to improve obtaining NPT in all patients.