The Diagnostic Value of Physical Examination and Additional Testing in Primary Care Patients With Suspected Heart Failure

Early diagnosis of nonacute heart failure is crucial because prompt initiation of evidence-based treatment can prevent or slow down further progression. To diagnose new-onset heart failure in primary care is challenging. This is a cross-sectional diagnostic accuracy study with external validation. S...

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Veröffentlicht in:Circulation (New York, N.Y.) N.Y.), 2011-12, Vol.124 (25), p.2865-2873
Hauptverfasser: KELDER, Johannes C, CRAMER, Maarten J, VAN WIJNGAARDEN, Jan, VAN TOOREN, Rob, MOSTERD, Arend, MOONS, Karel G. M, LAMMERS, Jan W, COWIE, Martin R, GROBBEE, Diederick E, HOES, Arno W
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Sprache:eng
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Zusammenfassung:Early diagnosis of nonacute heart failure is crucial because prompt initiation of evidence-based treatment can prevent or slow down further progression. To diagnose new-onset heart failure in primary care is challenging. This is a cross-sectional diagnostic accuracy study with external validation. Seven hundred twenty-one consecutive patients suspected of new-onset heart failure underwent standardized diagnostic work-up including chest x-ray, spirometry, ECG, N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement, and echocardiography in specially equipped outpatient diagnostic heart failure clinics. The presence of heart failure was determined by an outcome panel using the initial clinical data and 6-month follow-up data, blinded to biomarker data. 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 value (c-statistic 0.83). NT-proBNP was the most powerful supplementary diagnostic test, increasing the c-statistic to 0.86 and resulting in net reclassification improvement of 69% (P
ISSN:0009-7322
1524-4539
DOI:10.1161/CIRCULATIONAHA.111.019216