The Value of B Natriuretic Peptides in the Emergency Department for Managing Acute Dyspnea in Eledely Patients

ABSTRACT

Congestive heart failure (CHF) is the main cause of acute dyspnea and acute respiratory failure in elderly patients (> 65 years) presented to an emergency department (ED), and it is associated with high morbidity and mortality. Btype natriuretic peptide (BNP) is a polypeptide, released by ventricular myocytes directly proportional to wall tension, for lowering renin-angiotensin-aldosterone activation. For diagnosing CHF, both BNP and its biologically inactive N terminal fragment (NT-proBNP) have similar accuracy, even in the oldest (> 85 years). Threshold values are higher in elderly population. Studies demonstrated that the use of BNP or NT-proBNP in dyspneic patients early in the ED reduced the time to discharge and total treatment cost. BNP and NT-proBNP should be available in every ED 24 hours a day, because literature strongly suggests the beneficial impact of an early appropriate diagnosis and treatment in elderly dyspneic patients. The purpose of this article is to review their impact on clinical use in the emergency setting for elderly patients admitted for dyspnea.