Diagnosing non-acute heart failure in primary care settings

January 01, 0001

Diagnosing non-acute heart failure in primary care settings

If heart failure can be diagnosed early, proper treatment may arrest or decrease further progression. These Dutch and UK researchers performed a cross-sectional diagnostic accuracy study of patients suspected of new-onset heart failure. Enrollees underwent ECG, chest x-ray, spirometry, N- terminal pro-B-type natriuretic peptide (NT-proBNP) measurement, and cardiac echocardiography, compared to a gold standard of an blinded outcome panel that used both the initial clinical data and 6-month follow-up data.

The researchers found: "Of the 721 patients, 207 (28.7%) had heart failure. The combination of 3 items from history (age, coronary artery disease, and loop diuretic use) plus 6 from physical examination (pulse rate and regularity, displaced apex beat, rales, heart murmur, and increased jugular vein pressure) showed independent diagnostic. NT-proBNP was the most powerful supplementary diagnostic test, increasing the c-statistic to 0.86 and resulting in net reclassification improvement of 69%. A simplified diagnostic rule was applied to 2 external validation datasets… confirming the results."

The researchers concluded: "In this study, we estimated the quantitative diagnostic contribution of elements of the history and physical examination in the diagnosis of heart failure in primary care outpatients, which may help to improve clinical decision making. The largest additional quantitative diagnostic contribution to those elements was provided by measurement of NT-proBNP. For daily practice, a diagnostic rule was derived that may be useful to quantify the probability of heart failure in patients with new symptoms suggestive of heart failure."

It remains to be see how useful this diagnostic rule will be in practice.


For the full abstract, click here.

Circulation published ahead of print, 21 November 2011 © 2011 American Heart Association, Inc.
The Diagnostic Value of Physical Examination and Additional Testing in Primary Care Patients With Suspected Heart Failure. Johannes C. Kelder, Maarten J. Cramer, Jan van Wijngaarden, et al. Correspondence to J C Kelder: hans.kelder@gmail.com

Category: K. Circulatory. Keywords: heart failure, diagnosis, diagnostic rule, NT-proBNP, ECG, cross- sectional study, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 6 December 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

COVID-19 Resources

WONCA webinars, journal links and more

WONCA position statements

WONCA statements on a variety of issues

PEARLS

577 Individual behavioural counselling helps people to quit smoking 575 Antioxidant vitamin and mineral supplements may be beneficial in age-related macular degeneration 574 Oral antifungals effective for toenail onychomycosis 570 Decision aids beneficial for people facing health treatment or screening decisions 569 Computer-generated reminders on paper benefit quality of care