Low socioeconomic status is associated with reduced access to natriuretic peptide testing in the outpatient setting: a population-based evaluation

Background: Tests of natriuretic peptide (NP) concentrations are guideline-recommended for diagnosis and prognostication in heart failure (HF). Although NP testing is available at some hospitals, outpatient access has been limited to those who can pay out-of-pocket. We investigated whether residents who have lower socioeconomic status have differential access to NP testing.

Methods: Using a case-control design, we compared patients who had NP tests with age-matched patients undergoing non-NP blood tests (January 2015-June 2020), performed in the outpatient or acute hospital setting. The association of socioeconomic status measures (eg, deprivation quintile) with receipt of NP testing was assessed using conditional logistic regression, adjusted for sex, test location, and comorbidities, and was stratified by incidence of prior HF.

Results: Among 96,919 patients without prior HF (median age, 72 years; 50% female) who underwent NP testing, the majority of tests (66.6%) were performed in an acute hospital setting rather than in an outpatient clinic. Residents of more-deprived neighbourhoods had a higher incidence of HF (P < 0.001), but they were more likely to undergo NP testing in an acute care setting (odds ratio [OR] for most- vs least-deprived, 1.269; 95% confidence interval [CI], 1.104-1.216) and less likely to undergo testing as outpatients (OR, 0.807; 95% CI, 0.764-0.853 vs least-deprived; all P < 0.001). Among 70,362 matched patients with known HF (median aged, 78 years; 45% female), outpatient NP testing was also less likely to be performed among patients living in the most-deprived neighbourhoods (OR, 0.723; 95% CI, 0.677-0.772; P < 0.001).

Conclusions: Although those of lower socioeconomic status exhibit a higher risk of incident HF, they had less NP testing performed in outpatient settings, and more testing performed in resource-intense acute-care settings.