1. Primary care REFerral for EchocaRdiogram (REFER) in heart failure: a diagnostic accuracy study
- Author
-
Taylor, CJ, Roalfe, AK, Iles, R, Hobbs, FR, REFER investigators, Barton, P, Deeks, J, McCahon, D, Cowie, MR, Sutton, G, Davis, RC, Mant, J, McDonagh, T, Tait, L, Imperial College Trust, National Institute for Health Research, Mant, Jonathan [0000-0002-9531-0268], and Apollo - University of Cambridge Repository
- Subjects
Male ,Research design ,diagnostic ,heart failure ,030204 cardiovascular system & hematology ,clinical decision rule ,Electrocardiography ,Lethargy ,0302 clinical medicine ,Clinical Protocols ,Natriuretic Peptide, Brain ,Natriuretic peptide ,echocardiography ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Referral and Consultation ,Fatigue ,general practice ,medicine.diagnostic_test ,Middle Aged ,medicine.anatomical_structure ,England ,1117 Public Health And Health Services ,Research Design ,Cardiology ,Female ,Public Health ,Family Practice ,Adult ,medicine.medical_specialty ,medicine.drug_class ,Observational Study ,03 medical and health sciences ,Internal medicine ,Journal Article ,medicine ,Humans ,Validation Studies ,Aged ,Heart Failure ,Primary Health Care ,natriuretic peptide ,business.industry ,Research ,medicine.disease ,Peptide Fragments ,Confidence interval ,Dyspnea ,ROC Curve ,Heart failure ,Ankle ,business ,Biomarkers - Abstract
BackgroundSymptoms of breathlessness, fatigue, and ankle swelling are common in general practice but deciding which patients are likely to have heart failure is challenging.AimTo 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 settingProspective, observational, diagnostic validation study of patients aged >55 years, presenting with shortness of breath, lethargy, or ankle oedema, from 28 general practices in England.MethodThe 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.ResultsThree 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 ConclusionAt the low threshold of NT-proBNP
- Published
- 2016