To evaluate the level of N-terminal pro brain natriuretic peptide and brain natriuretic peptide (NTproBNP and BNP) for acute heart failure (AHF) diagnosis in patients aged 75 or older.

In a previous smaller study of very old patients with acute dyspnoea, despite being independently associated with the cardiac aetiology, BNP level was higher in cardiac vs. respiratory origin of dyspnea.

In total, 7822 patients aged 75 years or older, hospitalized in geriatrics, cardiologic and pneumologic department for acute dyspnoea in the enlarged Assistance Publique-Hôpitaux de Paris hospitals had a NTproBNP and a BNP measurement in the 48hours after admission. Mean (SD) age was 85.5 (5.9) years, 55,5% (n=4190) of patients were women. 72% (n=5636) were admitted from the emergency department. 4800 (63,5%) patients had AHF diagnosis at discharge. The NTproBNP levels were significantly higher in the AHF group (median=5598ng/L, interquartile range=2604;35000) than in the respiratory group (median=1290ng/L, interquartile range=433;20200; P<0.001). The BNP levels were significantly higher in the AHF group (median=574ng/L, interquartile range=303;3140) than in the respiratory group (median=152ng/L, interquartile range=66;813; P<0.001) (Fig. 1).

In patients over 75 years of age consulting for acute dyspnea, NTproBNP and levels are higher in patients with AHF than in other cause of dyspnea. In this population, the threshold of natriuretic peptides for AHF diagnostic might be increased.