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Zhang Y. Diagnostic value of echocardiography combined with serum C-reactive protein level in chronic heart failure. J Cardiothorac Surg 2023; 18:94. [PMID: 36966338 PMCID: PMC10040132 DOI: 10.1186/s13019-023-02176-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/29/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Chronic heart failure (CHF) is regarded as common clinical heart disease. This study aims to investigate the clinical diagnostic value of echocardiography (Echo) and serum C-reactive protein (CRP) levels in patients with CHF. METHODS A total of 75 patients with CHF (42 males, 33 females, age 62.72 ± 1.06 years) were enrolled as study subjects, with 70 non-CHF subjects (38 males, 32 females, age 62.44 ± 1.28 years) as controls. The left ventricular ejection fraction (LVEF), fraction shortening rate of the left ventricle (FS), and early to late diastolic filling (E/A) were determined by Echo, followed by an examination of the expression of serum CRP by ELISA. In addition, the Pearson method was used to analyze the correlation between echocardiographic quantitative parameters (EQPs) (LVEF, FS, and E/A) and serum CRP levels. Receiver operating characteristic (ROC) curve was adopted to evaluate the diagnostic efficacy of EQPs and serum CRP levels for CHF. The independent risk factors for CHF patients were measured by logistics regression analysis. RESULTS The serum CRP level of CHF patients was elevated, the values of LVEF and FS decreased, and the E/A values increased. ROC curve revealed that the EQPs (LVEF, FS, and E/A) combined with serum CRP had high diagnostic values for CHF patients. Logistic regression analysis showed that the EQPs (LVEF, FS, and E/A) and serum CRP levels were independent risk factors for CHF patients. CONCLUSION Echo combined with serum CRP level has high clinical diagnostic values for CHF patients.
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Affiliation(s)
- Yongxia Zhang
- Cardiovascular Medicine Department, The Third Affiliated Hospital of Guangzhou Medical University, No.63 Duobao Road, Liwan District, Guangzhou, 510150, Guangdong Province, China.
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2
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Chen S, He S. Analysis of Therapeutic Effect of Elderly Patients with Severe Heart Failure Based on LSTM Neural Model. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:7250791. [PMID: 36072726 PMCID: PMC9441360 DOI: 10.1155/2022/7250791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/06/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022]
Abstract
In recent years, cardiovascular-related diseases have become the "number one killer" threatening human life and health and have received much attention. The timely and accurate detection and diagnosis of arrhythmias and heart failure are relatively common heart diseases, which are of great social value and research significance in improving people's quality of life by providing early treatment or intervention for those who are at risk. Based on this, this paper proposes a deep learning network architecture based on the combination of long- and short-term memory networks and deep residual neural networks for the automatic detection of heart failure. A total of 60 elderly patients with severe heart failure treated in the emergency department of our hospital from August 2019 to August 2021 were selected as the sample subjects of this study. The treatment outcomes and prognostic quality of life of the two groups of patients were compared and analyzed. Based on the unbiased test method, the accuracy of the proposed method on the authoritative open continuous heart rate database PhysioNet was 99.67% (data length 500), 98.84% (data length 1000), and 96.63% (data length 2000). This indicates that the network model can well extract the high-dimensional features of continuous heart rate and improve the accuracy of the classification model. The LSTM neural model proposed in this paper may be able to provide richer information on heart health status for portable ECG detection systems, which have very important clinical value and social significance.
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Affiliation(s)
- Shunhong Chen
- Department of Emergency, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou 730000, Gansu, China
| | - Shoudu He
- Department of Emergency, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou 730000, Gansu, China
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Roalfe AK, Taylor CJ, Kelder JC, Hoes AW, Hobbs FDR. Diagnosing heart failure in primary care: individual patient data meta-analysis of two European prospective studies. ESC Heart Fail 2021; 8:2193-2201. [PMID: 33755352 PMCID: PMC8120419 DOI: 10.1002/ehf2.13311] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/27/2021] [Accepted: 03/02/2021] [Indexed: 12/28/2022] Open
Abstract
Aims Natriuretic peptides are helpful in detecting chronic heart failure (HF) in primary care; however, there are a lack of data evaluating thresholds recommended by clinical guidelines. This study assesses the diagnostic accuracy of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) using combined individual patient data from two studies in the UK and the Netherlands. Methods and results Random effects methods were used to estimate the performance characteristics of NT‐proBNP thresholds recommended by the European Society of Cardiology (ESC) and the UK National Institute for Health and Care Excellence (NICE) guidelines. New onset HF was diagnosed in 313 of 1073 (29.2%) participants. Age, sex, and atrial fibrillation‐adjusted NT‐proBNP was a better predictor of HF with reduced ejection fraction (HFrEF) than HF preserved ejection fraction (HFpEF), with area under receiver operating characteristic curve of 0.82 95% CI (0.78 to 0.86) vs. 0.71 (0.66 to 0.75). In persons aged 70 years and over, the ESC threshold at 125 ng/L for detection of all‐cause HF had summary negative predictive value (NPV) of 84.9% (81.6 to 88.2), positive predictive value (PPV) 68.1% (63.1 to 73.3), sensitivity 74.9% (69.5 to 80.3), and specificity 80.1% (76.9 to 83.4); the NICE threshold at 400 ng/L had summary NPV of 74.7% (72.1 to 77.2), PPV 81.8% (73.3 to 89.5), sensitivity 43.5% (37.2 to 49.8), and specificity 94.5% (92.3 to 96.7). Conclusions N‐terminal pro‐B‐type natriuretic peptide is better at detecting HFrEF than HFpEF in a primary care setting. In persons aged 70 and over, the ESC threshold of 125 ng/L is more accurate at detecting and excluding HF than the higher level suggested in NICE guidelines. More prospective data are required to establish the optimal NP threshold for detecting chronic HF in general practice.
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Affiliation(s)
- Andrea K Roalfe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | | | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht/Utrecht University, Utrecht, The Netherlands
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
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Forsyth F, Mant J, Taylor CJ, Hobbs FR, Chew-Graham CA, Blakeman T, Sowden E, Long A, Hossain MZ, Edwards D, Deaton C. Optimising Management of Patients with Heart Failure with Preserved Ejection Fraction in Primary Care (OPTIMISE-HFpEF): rationale and protocol for a multi-method study. BJGP Open 2019; 3:bjgpopen19X101675. [PMID: 31772040 PMCID: PMC6995858 DOI: 10.3399/bjgpopen19x101675] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/27/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is less well understood than heart failure with reduced ejection fraction (HFrEF), with greater diagnostic difficulty and management uncertainty. AIM The primary aim is to develop an optimised programme that is informed by the needs and experiences of people with HFpEF and healthcare providers. This article presents the rationale and protocol for the Optimising Management of Patients with Heart Failure with Preserved Ejection Fraction in Primary Care (OPTIMISE-HFpEF) research programme. DESIGN & SETTING This is a multi-method programme of research conducted in the UK. METHOD OPTIMISE-HFpEF is a multi-site programme of research with three distinct work packages (WPs). WP1 is a systematic review of heart failure disease management programmes (HF-DMPs) tested in patients with HFpEF. WP2 has three components (a, b, c) that enable the characteristics, needs, and experiences of people with HFpEF, their carers, and healthcare providers to be understood. Qualitative enquiry (WP2a) with patients and providers will be conducted in three UK sites exploring patient and provider perspectives, with an additional qualitative component (WP2c) in one site to focus on transitions in care and carer perspectives. A longitudinal cohort study (WP2b), recruiting from four UK sites, will allow patients to be characterised and their illness trajectory observed across 1 year of follow-up. Finally, WP3 will synthesise the findings and conduct work to gain consensus on how best to identify and manage this patient group. RESULTS Results from the four work packages will be synthesised to produce a summary of key learning points and possible solutions (optimised programme) which will be presented to a broad spectrum of stakeholders to gain consensus on a way forward. CONCLUSION HFpEF is often described as the greatest unmet need in cardiology. The OPTIMISE-HFpEF programme aims to address this need in primary care, which is arguably the most appropriate setting for managing HFpEF.
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Affiliation(s)
- Faye Forsyth
- Senior Research Nurse, Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Jonathan Mant
- Professor of Primary Care Research, Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Clare J Taylor
- General Practitioner and NIHR Academic Clinical Lecturer, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fd Richard Hobbs
- Nuffield Professor of Primary Care Health Sciences, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Carolyn A Chew-Graham
- Professor of General Practice Research, School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Thomas Blakeman
- Clinical Senior Lecturer in Primary Care, Centre for Primary Care, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Emma Sowden
- Research Associate, Centre for Primary Care, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Aaron Long
- Assistant Trial Manager, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Muhammad Zakir Hossain
- Research Assistant, Health Services Research, School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Duncan Edwards
- Senior Clinical Research Associate, Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Christi Deaton
- Florence Nightingale Foundation Clinical Professor of Nursing, Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
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Gallagher J, McCormack D, Zhou S, Ryan F, Watson C, McDonald K, Ledwidge MT. A systematic review of clinical prediction rules for the diagnosis of chronic heart failure. ESC Heart Fail 2019; 6:499-508. [PMID: 30854781 PMCID: PMC6487728 DOI: 10.1002/ehf2.12426] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 02/08/2019] [Indexed: 11/16/2022] Open
Abstract
Aims This study sought to review the literature for clinical prediction models for the diagnosis of patients with chronic heart failure in the community and to validate the models in a novel cohort of patients with a suspected diagnosis of chronic heart failure. Methods and results MEDLINE and Embase were searched from 1946 to Q4 2017. Studies were eligible if they contained at least one multivariable model for the diagnosis of chronic heart failure applicable to the primary care setting. The CHARMS checklist was used to evaluate models. We also validated models, where possible, in a novel cohort of patients with a suspected diagnosis of heart failure referred to a rapid access diagnostic clinic. In total, 5310 articles were identified with nine articles subsequently meeting the eligibility criteria. Three models had undergone internal validation, and four had undergone external validation. No clinical impact studies have been completed to date. Area under the curve (AUC) varied from 0.74 to 0.93 and from 0.60 to 0.65 in the novel cohort for clinical models alone with AUC up to 0.89 in combination with electrocardiogram and B‐type natriuretic peptide (BNP). The AUC for BNP was 0.86 (95% confidence interval 83.3–88.6%). Conclusions This review demonstrates that there are a number of clinical prediction rules relevant to the diagnosis of chronic heart failure in the literature. Clinical impact studies are required to compare the use of clinical prediction rules and biomarker strategies in this setting.
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Affiliation(s)
- Joe Gallagher
- School of Medicine & Medical Sciences, University College Dublin, Belfield, Dublin, 4, Ireland.,Irish College of General Practitioners, Lincoln Place, Dublin, Ireland
| | - Darren McCormack
- gHealth Research Group, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Shuaiwei Zhou
- Heartbeat Trust, Crofton Terrace, Dun Laoghaire, Co Dublin, Ireland
| | - Fiona Ryan
- Heartbeat Trust, Crofton Terrace, Dun Laoghaire, Co Dublin, Ireland
| | - Chris Watson
- Centre for Experimental Medicine, Queens University, Belfast, Ireland
| | - Kenneth McDonald
- School of Medicine & Medical Sciences, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Mark T Ledwidge
- School of Medicine & Medical Sciences, University College Dublin, Belfield, Dublin, 4, Ireland
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Povero M, Miceli A, Pradelli L, Ferrarini M, Pinciroli M, Glauber M. Cost-utility of surgical sutureless bioprostheses vs TAVI in aortic valve replacement for patients at intermediate and high surgical risk. CLINICOECONOMICS AND OUTCOMES RESEARCH 2018; 10:733-745. [PMID: 30510436 PMCID: PMC6231515 DOI: 10.2147/ceor.s185743] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Meta-analyses of studies comparing transcatheter aortic valve implants (TAVIs) and sutureless aortic valve replacement (SU-AVR) show differing effectiveness and safety profiles. The approaches also differ in their surgical cost (including operating room and device). OBJECTIVE The objective of this study was to assess the incremental cost-utility of SU-AVR vs TAVIs for the treatment of intermediate- to high-risk patients in the US, Germany, France, Italy, UK, and Australia. METHODS A patient-level simulation compares in-hospital pathways of patients undergoing SU-AVR or TAVIs; later, patient history is modeled at the cohort level. Hospital outcomes for TAVIs reproduce data from recent series; in SU-AVR patients, outcomes are obtained by applying relative efficacy estimates in a recent meta-analysis on 1,462 patients. After discharge, survival depends on the development of paravalvular leak and the need for dialysis. A comprehensive third-party payer perspective encompassing both in-hospital and long-term costs was adopted. RESULTS Due to lower in-hospital (4.1% vs 7.0%) and overall mortality, patients treated with SU-AVR are expected to live an average of 1.25 years more compared with those undergoing TAVIs, with a mean gain of 1.14 quality-adjusted life-years. Both in-hospital and long-term costs were lower for SU-AVR than for TAVIs with total savings ranging from $4,158 (France) to $20,930 (US). CONCLUSION SU-AVR results dominant when compared to TAVIs in intermediate- to high-risk patients. Both in-hospital and long-term costs are lower for SU-AVR than for TAVI patients, with concomitant significant gains in life expectancy, both raw and adjusted for the quality of life.
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Affiliation(s)
| | - Antonio Miceli
- Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
- Bristol Heart Institute, University of Bristol, Bristol, UK
| | | | - Matteo Ferrarini
- Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | | | - Mattia Glauber
- Minimally Invasive Cardiothoracic Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
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7
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Point-of-care B-type natriuretic peptide and portable echocardiography for assessment of patients with suspected heart failure in primary care: rationale and design of the three-part Handheld-BNP program and results of the training study. Clin Res Cardiol 2017; 107:95-107. [DOI: 10.1007/s00392-017-1181-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
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8
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Monahan M, Barton P, Taylor CJ, Roalfe AK, Hobbs FDR, Cowie M, Davis R, Deeks J, Mant J, McCahon D, McDonagh T, Sutton G, Tait L. MICE or NICE? An economic evaluation of clinical decision rules in the diagnosis of heart failure in primary care. Int J Cardiol 2017; 241:255-261. [PMID: 28366472 PMCID: PMC5483229 DOI: 10.1016/j.ijcard.2017.02.149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/28/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Detection and treatment of heart failure (HF) can improve quality of life and reduce premature mortality. However, symptoms such as breathlessness are common in primary care, have a variety of causes and not all patients require cardiac imaging. In systems where healthcare resources are limited, ensuring those patients who are likely to have HF undergo appropriate and timely investigation is vital. DESIGN A decision tree was developed to assess the cost-effectiveness of using the MICE (Male, Infarction, Crepitations, Edema) decision rule compared to other diagnostic strategies to identify HF patients presenting to primary care. METHODS Data from REFER (REFer for EchocaRdiogram), a HF diagnostic accuracy study, was used to determine which patients received the correct diagnosis decision. The model adopted a UK National Health Service (NHS) perspective. RESULTS The current recommended National Institute for Health and Care Excellence (NICE) guidelines for identifying patients with HF was the most cost-effective option with a cost of £4400 per quality adjusted life year (QALY) gained compared to a "do nothing" strategy. That is, patients presenting with symptoms suggestive of HF should be referred straight for echocardiography if they had a history of myocardial infarction or if their NT-proBNP level was ≥400pg/ml. The MICE rule was more expensive and less effective than the other comparators. Base-case results were robust to sensitivity analyses. CONCLUSIONS This represents the first cost-utility analysis comparing HF diagnostic strategies for symptomatic patients. Current guidelines in England were the most cost-effective option for identifying patients for confirmatory HF diagnosis. The low number of HF with Reduced Ejection Fraction patients (12%) in the REFER patient population limited the benefits of early detection.
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Affiliation(s)
- Mark Monahan
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Pelham Barton
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, University of Oxford, OX2 6GG, United Kingdom
| | - Andrea K Roalfe
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, University of Oxford, OX2 6GG, United Kingdom.
| | - Martin Cowie
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
| | - Russell Davis
- Department of Cardiology, Sandwell and West Birmingham Hospitals, Lyndon, West Bromwich, West Midlands B71 4HJ, United Kingdom
| | - Jon Deeks
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Jonathan Mant
- Department of Public Health & Primary Care, University of Cambridge, Strangeways Research Laboratory, Wort's Causeway, Cambridge CB1 8RN, United Kingdom
| | - Deborah McCahon
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Theresa McDonagh
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - George Sutton
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
| | - Lynda Tait
- School of Health Sciences, University of Nottingham, B Floor, South Block Link, Queen's Medical Centre, Nottingham NG7 2HA, United Kingdom
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Taylor CJ, Roalfe AK, Iles R, Hobbs FR, Barton P, Deeks J, McCahon D, Cowie MR, Sutton G, Davis RC, Mant J, McDonagh T, Tait L. Primary care REFerral for EchocaRdiogram (REFER) in heart failure: a diagnostic accuracy study. Br J Gen Pract 2017; 67:e94-e102. [PMID: 27919937 PMCID: PMC5308123 DOI: 10.3399/bjgp16x688393] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/21/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Symptoms of breathlessness, fatigue, and ankle swelling are common in general practice but deciding which patients are likely to have heart failure is challenging. AIM To evaluate the performance of a clinical decision rule (CDR), with or without N-Terminal pro-B type natriuretic peptide (NT-proBNP) assay, for identifying heart failure. DESIGN AND SETTING Prospective, observational, diagnostic validation study of patients aged >55 years, presenting with shortness of breath, lethargy, or ankle oedema, from 28 general practices in England. METHOD The outcome was test performance of the CDR and natriuretic peptide test in determining a diagnosis of heart failure. The reference standard was an expert consensus panel of three cardiologists. RESULTS Three hundred and four participants were recruited, with 104 (34.2%; 95% confidence interval [CI] = 28.9 to 39.8) having a confirmed diagnosis of heart failure. The CDR+NT-proBNP had a sensitivity of 90.4% (95% CI = 83.0 to 95.3) and specificity 45.5% (95% CI = 38.5 to 52.7). NT-proBNP level alone with a cut-off <400 pg/ml had sensitivity 76.9% (95% CI = 67.6 to 84.6) and specificity 91.5% (95% CI = 86.7 to 95.0). At the lower cut-off of NT-proBNP <125 pg/ml, sensitivity was 94.2% (95% CI = 87.9 to 97.9) and specificity 49.0% (95% CI = 41.9 to 56.1). CONCLUSION At the low threshold of NT-proBNP <125 pg/ml, natriuretic peptide testing alone was better than a validated CDR+NT-proBNP in determining which patients presenting with symptoms went on to have a diagnosis of heart failure. The higher NT-proBNP threshold of 400 pg/ml may mean more than one in five patients with heart failure are not appropriately referred. Guideline natriuretic peptide thresholds may need to be revised.
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Affiliation(s)
- Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Andrea K Roalfe
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - Rachel Iles
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - Fd Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - P Barton
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - D McCahon
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - M R Cowie
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London
| | - G Sutton
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London
| | - R C Davis
- Department of Cardiology, Sandwell and West Birmingham Hospitals, Lyndon, West Bromwich
| | - J Mant
- Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - T McDonagh
- Department of Cardiology, King's College Hospital, London
| | - L Tait
- School of Health Sciences, Nottingham
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10
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Smeets M, Degryse J, Janssens S, Matheï C, Wallemacq P, Vanoverschelde JL, Aertgeerts B, Vaes B. Diagnostic rules and algorithms for the diagnosis of non-acute heart failure in patients 80 years of age and older: a diagnostic accuracy and validation study. BMJ Open 2016; 6:e012888. [PMID: 27855108 PMCID: PMC5073666 DOI: 10.1136/bmjopen-2016-012888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Different diagnostic algorithms for non-acute heart failure (HF) exist. Our aim was to compare the ability of these algorithms to identify HF in symptomatic patients aged 80 years and older and identify those patients at highest risk for mortality. DESIGN Diagnostic accuracy and validation study. SETTING General practice, Belgium. PARTICIPANTS 365 patients with HF symptoms aged 80 years and older (BELFRAIL cohort). Participants underwent a full clinical assessment, including a detailed echocardiographic examination at home. OUTCOME MEASURES The diagnostic accuracy of 4 different algorithms was compared using an intention-to-diagnose analysis. The European Society of Cardiology (ESC) definition of HF was used as the reference standard for HF diagnosis. Kaplan-Meier curves for 5-year all-cause mortality were plotted and HRs and corresponding 95% CIs were calculated to compare the mortality risk predicting abilities of the different algorithms. Net reclassification improvement (NRI) was calculated. RESULTS The prevalence of HF was 20% (n=74). The 2012 ESC algorithm yielded the highest sensitivity (92%, 95% CI 83% to 97%) as well as the highest referral rate (71%, n=259), whereas the Oudejans algorithm yielded the highest specificity (73%, 95% CI 68% to 78%) and the lowest referral rate (36%, n=133). These differences could be ascribed to differences in N-terminal probrain natriuretic peptide cut-off values (125 vs 400 pg/mL). The Kelder and Oudejans algorithms exhibited NRIs of 12% (95% CI 0.7% to 22%, p=0.04) and 22% (95% CI 9% to 32%, p<0.001), respectively, compared with the ESC algorithm. All algorithms detected patients at high risk for mortality (HR 1.9, 95% CI 1.4 to 2.5; Kelder) to 2.3 (95% CI 1.7 to 3.1; Oudejans). No significant differences were observed among the algorithms with respect to mortality risk predicting abilities. CONCLUSIONS Choosing a diagnostic algorithm for non-acute HF in elderly patients represents a trade-off between sensitivity and specificity, mainly depending on differences between cut-off values for natriuretic peptides.
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Affiliation(s)
- Miek Smeets
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium
| | - Jan Degryse
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Stefan Janssens
- Department of Cardiovascular Diseases, Universitair Ziekenhuis Gasthuisberg, KU Leuven (KUL), Leuven, Belgium
| | - Catharina Matheï
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium
| | - Pierre Wallemacq
- Laboratory of Analytical Biochemistry, Cliniques Universitaires St Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Jean-Louis Vanoverschelde
- Department of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Bert Aertgeerts
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium
- Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium
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Palazzuoli A, Beltrami M, Ruocco G, Franci B, Campagna MS, Nuti R. Diagnostic utility of contemporary echo and BNP assessment in patients with acute heart failure during early hospitalization. Eur J Intern Med 2016; 30:43-48. [PMID: 26718066 DOI: 10.1016/j.ejim.2015.11.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/20/2015] [Accepted: 11/30/2015] [Indexed: 01/16/2023]
Abstract
BACKGROUND The use of B-type natriuretic peptide (BNP) and echocardiography in acute heart failure (AHF) diagnosis is poorly employed in the Emergency Department. The aim of the present study is to evaluate relation among BNP levels systolic and diastolic dysfunction during early phases of AHF hospitalization. METHODS We performed contemporary echocardiographic and BNP assessment in 310 patients with AHF within 12h since hospital admission. We studied the correlation among BNP and degree of diastolic dysfunction evaluated by pulsed Doppler transmitral flow and Tissue Doppler flow. Finally we investigated the relation among BNP and the right systolic longitudinal ventricular function (TAPSE) and the systolic pulmonary arterial pressure (PAPs). RESULTS BNP levels were 1417±1126, 1081±955, 894±901pg/mL, for patients with EF≤25%, EF 25-40% and EF 40-50% (p=0.005), respectively. "BNP levels linearly correlate with the degree of diastolic dysfunction: 582±406pg/mL in altered relaxation pattern, 712±557pg/mL in pseudonormal pattern and 1694±805 in restrictive filling pattern (p<0.001 for all patterns)." BNP levels were significantly increased in patients with right systolic ventricular dysfunction (TAPSE<18mm; p=0.006) and in patients with PAPs≥40mmHg (p=0.001). ROC curve and logistic regression analysis highlighted the power of BNP to detect severe systolic dysfunction, right ventricular (RV) overload and dysfunction and diastolic dysfunction patterns. CONCLUSIONS BNP levels correlate linearly with LV systolic dysfunction as well as with impaired degree of diastolic dysfunction. Significant PAP increase is a further factor influencing BNP elevation in patients with AHF during early hospitalization phase.
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Affiliation(s)
- Alberto Palazzuoli
- Cardiology Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital Siena, University of Siena, Italy.
| | - Matteo Beltrami
- Cardiology Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital Siena, University of Siena, Italy
| | - Gaetano Ruocco
- Cardiology Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital Siena, University of Siena, Italy
| | - Beatrice Franci
- Cardiology Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital Siena, University of Siena, Italy
| | - Maria Stella Campagna
- Cardiology Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital Siena, University of Siena, Italy
| | - Ranuccio Nuti
- Cardiology Unit, Department of Internal Medicine, S. Maria alle Scotte Hospital Siena, University of Siena, Italy
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Collerton J, Kingston A, Yousaf F, Davies K, Kenny A, Neely D, Martin-Ruiz C, MacGowan G, Robinson L, Kirkwood TBL, Keavney B. Utility of NT-proBNP as a rule-out test for left ventricular dysfunction in very old people with limiting dyspnoea: the Newcastle 85+ Study. BMC Cardiovasc Disord 2014; 14:128. [PMID: 25257704 PMCID: PMC4189162 DOI: 10.1186/1471-2261-14-128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/18/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Guidelines advocate using B-type natriuretic peptides in the diagnostic work-up of suspected heart failure (HF). Their main role is to limit echocardiography rates by ruling out HF/LV dysfunction where peptide level is low. Recommended rule-out cut points vary between guidelines. The utility of B-type natriuretic peptides in the very old (85+) requires further investigation, with optimal cut points yet to be established. We examined NT-proBNP's utility, alone and in combination with history of myocardial infarction (MI), as a rule-out test for LV dysfunction in very old people with limiting dyspnoea. METHODS DESIGN Cross-sectional analysis. SETTING Population-based sample; North-East England. PARTICIPANTS 155 people (aged 87-89) with limiting dyspnoea. MEASURES Dyspnoea assessed by questionnaire. Domiciliary echocardiography performed; LV systolic/diastolic function graded. NT-proBNP measured (Roche Diagnostics). Receiver operating characteristic analyses examined NT-proBNP's diagnostic accuracy for LV dysfunction. RESULTS AUC for LVEF less than or equal to 50% was poor (0.58, 95% CI 0.49-0.65), but good for LVEF less than or equal to 40% (0.80, 95% CI 0.73-0.86). At ESC cut point (125 ng/l), few cases of systolic dysfunction were missed (NPV 94-100%, depending on severity), but echocardiography (88%) and false positive rates (56-81 per 100 screened) were high. At NICE cut point (400 ng/l), echocardiography (51%) and false positive rates (33-45) were lower; exclusionary performance was good for LVEF less than or equal to 40% (1 case missed per 100 screened, 15% of cases; NPV 97%), but poor for LVEF less than or equal to 50% (16 cases missed per 100 screened, 45% of cases; NPV 68%). Incorporating isolated moderate/severe diastolic dysfunction into target condition increased the proportion of cases missed (lower NPV), whilst improving case detection. Incorporating MI history as an additional referral prompt slightly reduced the number of cases missed at expense of higher echocardiography and false positive rates. CONCLUSIONS High echocardiography rates and poor exclusionary performance for mild degrees of systolic dysfunction and for diastolic dysfunction limit NT-proBNP's utility as a rule-out test for LV dysfunction in very old people with limiting dyspnoea. Incorporating MI history as an additional echocardiography prompt yields no overall benefit compared to using NT-proBNP level alone.
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Affiliation(s)
- Joanna Collerton
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK.
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Bekkers SCAM, Brunner-La Rocca HP. Elderly primary care hypertension patients-who to refer for echocardiography? Neth Heart J 2014; 22:231-3. [PMID: 24676625 PMCID: PMC4016338 DOI: 10.1007/s12471-014-0550-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- S C A M Bekkers
- Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, the Netherlands,
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