The prognostic value of absolute and relative N-terminal pro brain natriuretic peptide (NT-proBNP) levels is different between young and older patients with acute decompensated heart failure.

However, the attainability of NT-proBNP levels is lower in elderly patients compared with younger patients, according to the data published in JACC: Heart Failure.

Susan Stienen, MD, of the Academic Medical Center in Amsterdam, The Netherlands, and colleagues sought to determine whether less effective NT-proBNP-directed therapy in older patients is related to differences in prognostic values or to the attainment of NT-proBNP itself.


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Researchers studied 1235 patients (59% male, 45% >75 years of age). Patients were categorized as being discharged with absolute discharge NT-proBNP levels of <1500, <3000, <5000, and <15 000 ng/L, and with relative NT-proBNP reductions of >30%, >50%, and >70% from admission to discharge.

The study end point was all-cause mortality within 6 months post-discharge and the distribution of the end point among the NT-proBNP categories of absolute discharge and relative reduction levels was evaluated for young (≤75 years of age) and elderly (>75 years of age) patients.

Prognostic value of absolute and relative NT-proBNP levels was similar among the age groups. Attainability was significantly lower in older patients for all absolute levels and >50% relative reduction, but not for >30% and >70%.

“For absolute levels, attainability differences between age groups were decreased to a large extent after correction for admission NT-proBNP and anemia at discharge,” they wrote. “For relative levels, attainability differences disappeared after correction for heart failure etiology and anemia at discharge.”

Researchers concluded that future studies should focus on attainability of NT-proBNP targets in both young and elderly patients.

Reference

Stienen S, Salah K, Eurlings LW, et al. Targeting NT-proBNP in older vs younger acute decompensated heart failure patients. JACC Heart Fail. 2016. doi:10.1016/j.jchf.2016.05.007.