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guided by N-terminal brain natriuretic peptide (BNP) has been proposed to improve outcome compared with conventional therapy in patients with chronic heart failure in some studies. [1][2][3][4] However, these studies were small (n = 69, 1 n = 220, 2 n=130 3 ), not conclusive, 3,4 had limited follow-up, focused on younger patients, 2,3 and/or have not yet been published in detail. 3,4 The concept of an intensified N-terminal BNP-guided therapy might be particularly attractive in older patients who are less physically active and in whom symptoms are less reliable, but they also may be more susceptible to drug-related adverse effects. Problems of heart failure increase with age. 5 Heart failure is the most common reason for hospitalization in patients aged 65 years or older. 6 Older patients are underrepresented in randomized controlled trials, 7 mainly be-For editorial comment see p 432.

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