Re-evaluation of prognostic significance of NT-proBNP in a 5-year follow-up study assessing all-cause mortality in elderly patients (≥ 75 years) admitted to hospital due to suspect heart failure

Abstract

BackgroundN-terminal pro-B-type natriuretic peptide (NT-proBNP) is a prognostic biomarker in heart failure (HF), especially in younger population. The prognostic value of NT-proBNP in an elderly HF population (≥75 years) remains less studied. The purpose of this study is to evaluate the prognostic value of NT-proBNP in patients aged≥75 years and admitted to hospital due to suspect HF with a median follow-up of 5 years. MethodsA prospective hospital cohort of 243 patients (82±4 years) who had NT-proBNP analyzed due to suspect HF during 2005–2007 was studied. ResultsAmong the study population, 75% had acute decompensated HF. Multivariable Cox proportional-hazard regression analysis and univariable Kaplan-Meier survival analysis demonstrated that NT-proBNP was not prognostic significant in HF cohort≥75 years old, and instead, pulmonary hypertension, history of valvular surgery and use of aldosterone receptor antagonist were significant prognostic indicators. However, subgroup analysis showed that in patients with NT-proBNP levels>8000 (ng/L), NT-proBNP is the only significant independent indicator for 5-year mortality whereas in patients with NT-proBNP≤8000(ng/L), enlargement of left atrium and pulmonary hypertension, instead of NT-proBNP, were significant prognostic indicators for mortality. ConclusionIn a HF population≥75 years old with acute decompensated HF, NT-proBNP was not significant prognostic indicator, except in a subgroup with NT-proBNP>8000 (ng/L). Therefore, the prognostic value of NT-proBNP in those HF patients≥75 years has to be interpreted with caution due to higher age and comorbidity.