title: Targeting N-Terminal Pro-Brain Natriuretic Peptide in Older Versus Younger Acute Decompensated Heart Failure Patients.
abstract: The aim of this study was to analyze the prognostic value and attainability of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in young and elderly acute decompensated heart failure (ADHF) patients.
  
  
  
  Less-effective NT-proBNP-guided therapy in chronic heart failure (HF) has been reported in elderly patients. Whether this can be attributed to differences in prognostic value of NT-proBNP or to differences in attaining a prognostic value is unclear. The authors studied this question in ADHF patients.
  
  
  
  Our study population comprised 7 ADHF cohorts. We defined absolute (<1,500 ng/l, <3,000 ng/l, <5,000 ng/l, and <15,000 ng/l) and relative NT-proBNP discharge cut-off levels (>30%, >50%, and >70%). Six-month all-cause mortality after discharge was studied for each level in Cox regression analyses, and compared between elderly (age >75 years) and young patients (age ≤75 years). Thereafter, we compared percentages of elderly and young patients attaining NT-proBNP levels (= attainability).
  
  
  
  A total of 1,235 patients (59% male, 45% >75 years of age) was studied. Admission levels of NT-proBNP were significantly higher in elderly versus younger patients. The prognostic value of absolute and relative NT-proBNP levels was similar in elderly and young patients. Attainability was significantly lower in elderly patients for all absolute levels and a >50% relative reduction, but not for >30% and >70%. For absolute levels, attainability differences between age groups were decreased to a large extent after correction for admission NT-proBNP and anemia at discharge. For relative levels, attainability differences disappeared after correction for HF etiology and anemia at discharge.
  
  
  
  In young and elderly ADHF patients, it is not the prognostic value of absolute and relative NT-proBNP levels that is different, but the attainability of these levels that is lower in the elderly. This can largely be attributed to factors other than age.
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Susan
authors.initials: S
authors.lastname: Stienen
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Khibar
authors.initials: K
authors.lastname: Salah
authors.affiliation: Department of Cardiology, VieCuri Medical Center, Venlo, the Netherlands.
authors.forename: Luc W
authors.initials: LW
authors.lastname: Eurlings
authors.affiliation: Department of Internal Medicine, Hospital S. João, University of Porto Medical School, Porto, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
authors.affiliation: Department of Internal Medicine, Hospital S. João, University of Porto Medical School, Porto, Portugal.
authors.forename: Joana M
authors.initials: JM
authors.lastname: Pimenta
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.affiliation: Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
authors.affiliation: Department of Internal Medicine and Emergency, Careggi University Hospital, Florence, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Verdiani
authors.affiliation: Department of Cardiology, Azienda Istituti Ospitalieri di Cremona, Cremona, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Bettari
authors.affiliation: Department of Cardiology, Ospedale San Pellegrino, Castiglione delle Stiviere, MN, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Lazzarini
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Jan P
authors.initials: JP
authors.lastname: Tijssen
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Yigal M
authors.initials: YM
authors.lastname: Pinto
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands. Electronic address: w.e.kok@amc.uva.nl.
authors.forename: Wouter E
authors.initials: WE
authors.lastname: Kok
mesh_terms: D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002423:Cause of Death; D018450:Disease Progression; D004232:Diuretics / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D009026:Mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010347:Patient Care Planning; D010446:Peptide Fragments / Q000097:blood*; D016016:Proportional Hazards Models
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: NT-proBNP targets; acute decompensated heart failure; elderly; young