B-Type natriuretic peptide in the management of older persons with heart failure.
B-type natriuretic peptide (BNP) and the inactive N-terminal fragment of the precursor (NT-proBNP) are hormones predominantly produced by the cardiac myocyte. It has been shown that very high levels of circulating natriuretic peptides correlate with a diagnosis of heart failure. In view of this, the current NICE, SIGN and European Society of Cardiology guidelines on heart failure recommend the measurement of natriuretic peptides as part of the diagnostic pathway for patients with suspected heart failure in primary care. Patients should be stratified according to results with high risk patients referred and reviewed by specialist services within 2 weeks. There has also been interest regarding the potential use of natriuretic peptides in disease surveillance, therapeutic monitoring and inpatient discharge planning. Consequently, it is a test that we will encounter with increasing frequency in clinical practice.
Heart failure is common in older persons; hence geriatricians need to have an understanding of the implications of natriuretic peptide levels. The test can be affected by both physiological and pharmacological factors and this should be taken into consideration when interpreting results.