Comparison of the Diagnostic Accuracy of Plasma N-Terminal Pro-Brain Natriuretic Peptide in Patients 80 Years of Age with Heart Failure

Plasma N-Terminal Pro-Brain Natriuretic Peptide (NTproBNP) is known to increase with age, however, the performance of this biomaker is unclear in patients >80. This study sought to define the diagnostic accuracy of plasma NTproBNP in patients >80 in a large unselected population of heart failure (HF) patients admitted to a Tertiary Hospital in the United Kingdom. 1,995 consecutive patients over a 12 month period were screened for HF through our NTproBNP led HF service. 413 patients had their first presentation of HF and 36.1% of these patients were >80. There was a reduction in accuracy of NTproBNP with age according to the area under the curve, with an area under the curve for all HF patients of 0.734 and a 7.5% reduction in receiver operating characteristic curve area for patients >80 years compared with those under 60 to 79 years of age. The lowest NTproBNP recorded for patients with HF >80 years of age was 466 pg/ml. In HF patients >80, 40.6% patients were diagnosed with HFrEF, 31.1% with HFpEF and 28.2% with HFmrEF. Overall NTproBNP is less accurate at identifying HF in patients >80 years of age and the lowest NTproBNP recorded for a HF patient was 466 pg/ml suggesting that the NTproBNP threshold for ruling out HF in patients >80 years of age should be modified.