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Heart failure (HF) represents the terminal clinical stage of a broad spectrum of cardiac disorders, distinguished by notably high rates of incidence and mortality. Extensive clinical investigations have proved that monitoring of N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels can reliably forecast HF and inform targeted clinical decision-making. Current detections for NT-proBNP depend on centralized laboratory instrumentation, which frequently creates delays that hinder the delivery of timely clinical care and decision-making. Here, we present a wearable microneedle-based electrochemical aptamer sensor (MEAS) for real-time, dynamic monitoring detection of NT-proBNP. Furthermore, this MEAS integrates real-time signal processing with wireless communication capabilities (e.g., Bluetooth to smartphones), enabling dynamic data analysis and visual reading out of the NT-proBNP level. In vitro characterization demonstrated high analytical performance, including a wide linear range (10-2000 pg/mL), a low detection limit (8.61 pg/mL), excellent selectivity against common interferents, and stable responses over repeated measurements. The microneedle biosensor exhibited favorable biosafety and enabled reliable in vivo NT-proBNP monitoring, with good agreement between sensor readouts and ELISA measurements. Together, these results position the proposed microneedle aptasensor as a promising alternative to conventional blood-based testing, with the potential to support real-time, patient-centered monitoring and advance next-generation HF management strategies.