Importancia de la medida de las concentraciones plasmáticas del péptido natriurético ventricular (BNP) en el seguimiento de pacientes ancianos con insuficiencia cardiaca

Abstract

Heart failure (HF) is a health public problem that is becoming increasingly more common due to the ageing of population1;2. It has been estimated that the prevalence of HF is about 10% in patients > 70 years, and after 5 years of follow-up, survival only reaches 50%. Moreover, HF is the main cause of hospital admissions in patients > 65 years3;4. Decompensated HF is defined by the development of new-onset or worsening signs and symptoms of HF. Despite this simple definition, decompensated HF represents a constellation of signs and symptoms that reflect heterogeneous etiologies and precipitants. Moreover, signs and symptoms are frequently difficult to identify in elderly patients5. Patients hospitalized for decompensated HF have a higher mortality and are at increased risk for new cardiovascular events. As a result, it is necessary to perform different strategies to reduce episodes of decompensated HF through a better monitoring of these patients. This will improve the quality of life of this population and will reduce health costs related to HF1;3-6. Natriuretic peptides (NPs) have been shown to be useful for the diagnosis of HF. Moreover, they have been useful to estimate the prognosis of patients with HF, and are helpful for monitoring the response to therapy of patients with acute DHF6-13. Changes in BNP values during the follow-up may be helpful for monitoring patients with HF and for the early diagnosis of decompensated HF episodes. This may reduce hospitalizations for HF, healthcare costs, and improve quality of life of these patients14,15. However, it has been suggested that the biomarker-guided HF approach could be less effective in elderly patients16. Moreover, the optimal cut-off level for ruling out HF in elderly patients with other co-morbidities is still not clear, as NPs may increase in other situations different to HF that are common in elderly such as renal dysfunction, atrial fibrillation, or pulmonary disease5. The aim of this study was to analyze whether the changes in BNP levels during the follow-up could predict better than baseline BNP values the development of decompensated HF episodes in elderly outpatients