Newswise — A new study published in Circulation by University of Alabama at Birmingham researchers showed that Black heart failure patients have worse prognoses even after achieving biomarker-based treatment goals.  

Vibhu Parcha, M.D., a clinical research fellow in the Division of Cardiovascular Disease, says prior studies have shown that those heart failure patients who take medications regularly and have their NT-proBNP levels — a heart failure biomarker — less than 1,000 pg/mL do better in terms of being admitted to hospital for worsening of heart failure or dying due to cardiac causes. 

Heart failure affects nearly 5 million patients in the United States, and there are key racial differences in the disease pathophysiology and care of heart failure patients, according to Parcha.  Therefore, it is important to understand the racial differences in the prognosis of heart failure patients who achieve the treatment goal of NT-proBNP levels of less than 1,000.

In this investigation, Parcha and his team analyzed the data from the heart failure patients enrolled in the NHLBI-sponsored Guiding Evidence-Based Therapy Using Biomarker-Intensified Treatment in Heart Failure trial.

“The assessment of heart failure patients in the setting of a randomized clinical trial allowed us to look closely at the racial differences in the clinical characteristics and outcomes of heart failure patients,” Parcha said.

Researchers found that, regardless of race, heart failure patients who achieve the treatment goal of NT-proBNP levels ≤1,000 pg/mL were less likely to be admitted with worsening heart failure or die due to cardiovascular reasons. Notably, they found that Black heart failure patients had worse prognoses compared to their white counterparts at any level of the NT-proBNP levels reached. 

“Heart failure is a serious medical condition, and all heart failure patients require close medical attention and care,” said senior author Pankaj Arora, M.D., a physician-scientist in the UAB Division of Cardiovascular Disease. “We have previously shown that even healthy Black individuals have lower levels of beneficial hormones produced by the heart called natriuretic peptides. The diseased heart in conditions like heart failure produces higher levels of these hormones. As heart failure worsens, the secretion of the hormone increases as a reflection of the activation of the neurohormonal system. Therefore these hormones act as a gold-standard biomarker for the status of heart failure. With appropriate treatment, we can improve the functioning of the heart, which in turn causes a reduction in this biomarker hormone.”   

Arora adds that it is important for patients to take their heart failure medications regularly and seek medical care to ensure that their medications are being changed adequately based on their clinical condition.   

“Both Black individuals and white individuals with heart failure have a good prognosis when they are receiving adequate medical care for their heart failure and also have their biomarker (NT-proBNP) levels less than 1,000,” he said. “However, Black heart failure patients had worse prognosis irrespective of attainment of the biomarker targets, which indicates that aggressive up-titration of goal-directed therapy must be done for these heart failure patients despite the attainment of biomarker goals. These racial differences in the care are important as Black individuals are at a greater risk of developing cardiovascular diseases such as heart failure and need to be treated adequately once the disease develops.”

This work was supported by the National Institutes of Health grant, and the UAB Minority Health and Health Disparities Research Center research grant to Arora.

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Circulation