Current European Society of Cardiology guidance recommends referral for specialist heart failure (HF) assessment at NT-proBNP levels of 125 pg/mL, while UK NICE guidelines use a higher threshold of 400 pg/mL. A single-center observational study presented at Heart Failure 2026 evaluated outcomes among adults older than 75 referred with NT-proBNP levels between 400 and 499 pg/mL to assess the potential implications of higher age-adjusted referral thresholds.

The study included patients referred from primary care to a UK rapid-access HF clinic between January 2022 and December 2024. Referral decisions incorporated NT-proBNP levels, HF signs and symptoms, and pulse assessment for atrial fibrillation. Among 980 referred patients older than 75 years, 56 had NT-proBNP levels between 400 and 499 pg/mL.

Findings

• Among 46 eligible patients, HF was ultimately diagnosed in 24% (n=11).
• HF diagnoses included seven patients with HFpEF and two with HFmrEF identified at first review.
• One additional patient was classified as having Stage B HFpEF (“pre-HF”).
• No newly diagnosed HFrEF cases were identified.
• One patient with HFmrEF was subsequently diagnosed with cardiac amyloidosis and experienced one HF hospitalization, while another HFmrEF patient had two HF hospitalizations during follow-up.
• Severe aortic stenosis was identified in two patients without a HF diagnosis.
• Across the 11 patients ultimately diagnosed with HF, four hospitalizations and one death occurred during a mean follow-up of 27.4 months.

In this older outpatient cohort with NT-proBNP levels between 400 and 499 pg/mL, approximately one-quarter of patients were ultimately diagnosed with HF, predominantly HFpEF with generally mild disease severity.