Association between B-type natriuretic peptide levels and NYHA functional class in older home-care patients with atherosclerotic heart disease: a cross-sectional study

Atherosclerotic heart disease (AHD) is a major contributor to cardiovascular morbidity and may lead to subclinical myocardial dysfunction and eventual heart failure (HF), particularly in elderly populations. B-type natriuretic peptide (BNP) and New York Heart Association (NYHA) functional classification are valuable tools for early HF detection. However, data on their use in home healthcare settings remain limited. This study aimed to examine the association between BNP levels and NYHA functional class in elderly home-care patients diagnosed with AHD but without a prior HF diagnosis. A cross-sectional observational study was conducted with 56 home healthcare patients diagnosed with AHD but not HF. Sociodemographic and clinical data were collected during home visits. NYHA functional status was evaluated clinically and BNP levels were analyzed. Statistical analyses included logistic and linear regression models to identify predictors of advanced functional class and elevated BNP. The mean age of the participants was 83.1 ± 8.0 years, and 66.1% were female. The median BNP level was 119.0 pg/mL (IQR: 71.2–231.0). A total of 39.3% of participants were classified as NYHA class III or IV. BNP levels were significantly higher in patients with advanced NYHA class ( P < 0.001). Logistic regression revealed that BNP was an independent predictor of NYHA class III–IV (adjusted OR 1.08 per 10 pg/mL increase, P = 0.004). In linear regression, male sex and NYHA class III–IV were independent predictors of higher log-transformed BNP levels. Elevated BNP levels and impaired functional status are common among elderly home-care patients with AHD but without a formal HF diagnosis, and BNP is significantly associated with more advanced NYHA class. Without echocardiographic confirmation, this association cannot be equated with detection of undiagnosed heart failure; combined BNP and NYHA assessment during home visits may nonetheless help flag high-risk patients for timely hospital-based cardiology evaluation, pending prospective validation, addressing a critical gap in cardiac care for patients with limited hospital access.