NT-pro BNP as a Prognostic Indicator for Chronic Heart Failure in Geriatric Population - A Pilot Study

Background As per the updated NICE guidelines, brain (B-type) natriuretic peptide (BNP) is used in the diagnostic criteria and management of heart failure. In this study, we aimed to evaluate the prognostic value of the inactive N-terminal fragment NT-proBNP in an elderly population with decompensated heart failure. Materials & Methods We conducted a retrospective observational cohort study of 88 elderly patients who were admitted with decompensated heart failure between September 2023 to April 2024, covering the South Eastern Trust in Northern Ireland. Suspected heart failure admissions were randomly selected to obtain snapshots of each month. Among these admissions, 88 heart failure cases were identified based on echocardiogram findings and NT-proBNP levels obtained at initial admission. The same cohort was followed up for 12 weeks to monitor two specific end points: re-admission with heart failure or death. Heart failure follow-ups were also assessed post-discharge. All cases were categorized into two main cohorts: a heart failure with reduced ejection fraction (HFrEF/EF > 60%) cohort and a heart failure with preserved ejection fraction (HFpEF/EF > 40%) cohort. Prognostic values and all-cause mortality after discharge were assessed for each cohorts via multivariable adjusted Cox regression analysis. Each cohort was further divided into three sub-cohorts based on NT-proBNP value Results The data analysis showed that patients with NT-proBNP values of >2000 exhibited a mortality rate of 29.1% and a heart failure re-admission rate of 45.6%. Those with rising NT-proBNP values during heart failure follow-up exhibited a re-admission rate of 66.6%, which was much lower than that (33.3%) seen in those with declining NT-proBNP values. Conclusions Our results indicated that higher NT-proBNP levels on admission were predictive of higher mortality and re-admission rates among the elderly population. Furthermore, rising NT-proBNP levels during heart failure follow up were associated with higher mortality and morbidity rates. Therefore, NT-proBNP levels can be used as a prognostic biomarker for elderly patients with heart failure, irrespective of their ejection fraction status.