Cardiac Overload and Heart Failure Risk by NT-proBNP Levels in Older Adults with COPD Eligible for Single-Inhaler Triple Therapy: A Multicenter Longitudinal Study

<b>Background:</b> In common clinical practice, cardiac overload is still often overlooked in patients with chronic obstructive pulmonary disease (COPD) despite its substantial impact on clinical outcomes and mortality. This study aimed to assess the prevalence of cardiac overload and heart failure (HF) risk, using N-terminal pro-B-type natriuretic peptide (NT-proBNP), in older COPD patients eligible for single-inhaler triple therapy (SITT) and without history of overt HF. We also evaluated changes in NT-proBNP after 3 months of SITT. <b>Methods:</b> This multicenter observational study included 165 older outpatients with a recent moderate-to-severe acute exacerbation of COPD (AECOPD), categorized as 'Group E' according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Patients were stratified for the presence of cardiac overload and HF risk using age- and comorbidity-adjusted NT-proBNP thresholds, as recommended by the 2023 Clinical Consensus Statement of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). NT-proBNP was measured at baseline and after three months of SITT (116 patients with available test at three months). <b>Results:</b> Mean age was 80.7 ± 9.7 years. Patients with NT-proBNP levels indicative of "HF likely" and "HF very high-risk" were 43.0% and 24.2%, respectively. After 3 months of SITT, NT-proBNP significantly decreased by 7.2% (95%CI 9.0-5.4%, <i>p</i> < 0.001), with the largest reductions observed in younger patients [11.0% (95% CI 14.1-7.2%) ≤ 76 years old, 8.4% (95% CI -11.3-5.5%) in 77-87 years old, -3.0% (95% CI -6.1-0.0%) in ≥88 years old, p for interaction = 0.007]. <b>Conclusions:</b> In real-life clinical practice, a substantial proportion of older patients with GOLD Group E COPD had elevated NT-proBNP, suggestive of cardiac overload and high risk of HF. The early identification of these patients may prompt further cardiologic evaluation and management. After SITT and before cardiology evaluation, a significant NT-proBNP reduction has been observed, suggesting potential cardiovascular benefit of SITT.