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ADHERENCE TO CHOLINESTERASE INHIBITORS IN PATIENTS WITH ALZHEIMER'S DISEASE

BNP category and history of heart failure were the independent factors related to mortality. Of the 147 patients with no history of heart failure (73%), survival was significantly lower in those with plasma BNP values greater than 300 pg/mL than in those with BNP lower than 100 pg/mL or between 100 and 300 pg/mL. This study found that plasma BNP measured under stable conditions was a prognostic indicator for mortality in frail and very old patients. This relationship was found independently of a history of heart failure and in very old patietns and patients with a high prevalence of comorbidities and functional decline. These findings are in agreement with those of other studies conducted in elderly patients with chronic heart failure and in geriatric patients with no history of hospitalization for cardiac disease and no evidence of heart failure. In community-dwelling subjects with no history of hospitalization for heart failure, BNP was significantly related to 2-year morbidity and mortality. This study and two others strongly support the view that plasma BNP has a prognostic value in old individuals with no history of heart failure. In these subjects, high levels of plasma BNP might indicate subclinical heart dysfunction. In addition, high BNP levels might also indicate a pronounced effect of aging on diastolic function and heart vulnerability to hemodynamic stress, although in the current study, it was not possible to investigate these hypotheses, because echocardiography assessment was not available for all patients. In addition, it was difficult to obtain reliable information about cardiac morbidity during the follow-up and causes of death. In the current study, the threshold of 300 pg/mL was dramatically informative about prognosis. This might encourage physicians to pay special attention to elderly patients with plasma BNP levels greater than 300 pg/mL, even if they are free from heart failure. Studies have shown that management of heart failure patients targeted to lower plasma BNP levels improves the prognosis of these patients. Further studies are needed to determine whether a specific therapeutic approach can improve the prognosis of elderly patients free of heart failure with high plasma BNP levels.