Key result
~68% of healthy older adults exceed the NT-proBNP heart failure rule-out cut-off.
Why the study?
Older individuals have elevated NT-proBNP levels even when cardiovascularly healthy, but reference values remain scarce.
Does the healthy old and very old population have NT-proBNP values above the standard heart failure rule-out cut-off of 125 pg/mL?
Cross-Sectional (n=2,304)
Does the healthy old and very old population have NT-proBNP values above the standard heart failure rule-out cut-off of 125 pg/mL?
More than 50% of healthy subjects aged 70 years and older have NT-proBNP values above the standard 125 pg/mL cut-off, suggesting age-adjusted reference values are needed to prevent unnecessary heart failure diagnostics.
Answers are grounded in this paper and cite their sources.
May prompt caution applying the 125 pg/mL cutoff in healthy elderly; leaves open validation of age-specific NT-proBNP references in prospective studies.
BACKGROUND: High NT-proBNP is an established marker of heart failure. However, old individuals have elevated values even when cardiovascularly healthy. Reference values remain scarce. OBJECTIVES: We sought to provide reference values of NT-proBNP for the healthy old and very old population and the proportion above the AHA- and ESC-recommended rule-out cut-off for heart failure diagnosis in a non-acute setting (≥ 125 pg/mL). METHODS: We analyzed cross-sectional data from the population-based AugUR study of inhabitants ≥ 70 years of age. NT-proBNP was determined in serum. Cardiac morphology and function were evaluated by echocardiography. RESULTS: A total of 2304 subjects aged 70 to 95 years were analyzed (52% women; 35% ≥ 80 years). Median NT-proBNP increased by age group (70-74/75-79/80-84/ ≥ 85 years: 153.0/176.9/228.5/395.0 and 116.1/171.5/217.6/437.0 pg/mL for women or men, respectively); 68% had NT-proBNP ≥ 125 pg/mL. In a subgroup free of cardiovascular risk factors, renal failure, coronary artery disease, and atrial fibrillation (n = 685), 50% (70-79 years) and 70% (≥ 80 years) had NT-proBNP ≥ 125 pg/mL; 97.5% quantiles were considerably higher than 125 pg/mL (70-79 years: 559.5 or 424.5 for women or men; 80-95 years: 809.2 or 722.0 pg/mL for women or men). When further restricting to normal left ventricular mass, E/e' ratio, and ejection fraction (n = 65), 53% of subjects (70-79 years) or 50% (≥ 80 years) had NT-proBNP ≥ 125 pg/mL. CONCLUSIONS: NT-proBNP levels continue to rise in the very old population. More than 50% of healthy subjects aged 70 years and older have NT-proBNP values above the decision-making cut-off at 125 pg/mL, potentially causing unnecessary further diagnostics and referrals.
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Heinrich et al. (2025) conducted a cross-sectional in Healthy old and very old population (n=2,304). Age ≥ 70 years was evaluated on Proportion of subjects with NT-proBNP ≥ 125 pg/mL. NT-proBNP levels continue to rise with age, with over 50% of cardiovascularly healthy subjects aged 70 years and older having values above the 125 pg/mL rule-out cut-off for heart failure.
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