Setting the optimal threshold of NT-proBNP/BNP for the diagnosis of heart failure in patients over 75 years

Background The diagnosis of acute heart failure (AHF) continues to be a challenge in older patients. Natriuretic peptides are recommended in the diagnosis of AHF. Aims To determine the diagnostic threshold of BNP and NT-proBNP as a diagnostic tool for acute heart failure (AHF) in patients over 75 years old with and without comorbidities. Methods and Results In this retrospective longitudinal multicenter cohort study, we collected data from 12,974 patients aged 75 years or older who were hospitalized for acute dyspnea with BNP or NT-proBNP measurement in the 48 hours after admission in 10 Assistance Publique-Hôpitaux de Paris between 2011 and 2021 in geriatrics, cardiology, and pulmonology departments. The final diagnosis was classified with ICD 10 as either “AHF” or other acute respiratory failure, represented by COPD exacerbation and pneumonia. The Mean (SD) age of our population was 84.4 (6.1) years old, and 52.7% of patients were women. 8,385 (64.6%) patients had an AHF diagnosis at discharge. For BNP and NT-proBNP, we found threshold with good sensitivity and specificity, for the age-dependent cutoffs of 85 yo, in older patients with atrial fibrillation, in older patients with CrCl < 40 ml/min, and in older patient with obesity. Conclusion In older patients, we found significant effects of comorbidities on natriuretic peptides results, particularly in patients over 85 year old, older patients with abnormal renal function, obesity and atrial fibrillation. Despite the consideration of those comorbid conditions, NT-proBNP and BNP level continue to demonstrate utility in the diagnosis of AHF in older patients.