Recognising heart failure in elderly patients with stable chronic obstructive pulmonary disease in primary care: cross sectional diagnostic study
Key result
A diagnostic evaluation using clinical history, physical examination, NT-proBNP, and electrocardiography identified concomitant heart failure in 20.5% of patients with stable COPD, with ROC area improved to 0.77 when NT-proBNP was added to the clinical model.
Why the study?
Does a diagnostic model combining clinical variables, NT-proBNP, and electrocardiography improve the identification of concomitant heart failure in elderly patients with stable COPD?
Population
Elderly patients with stable chronic obstructive pulmonary disease in primary care, without a previously…
Design
Cross-sectional, Chest radiographs, pulmonary function tests…
Authors
Discussion
Loading...
Member takes
Implication
May aid HF detection in stable COPD; supports consensus yet leaves open need for prospective validation.
Study Design
Type
Cross-Sectional (n=405)
Multicenter
Yes
Structured PICO
Does a diagnostic model combining clinical variables, NT-proBNP, and electrocardiography improve the identification of concomitant heart failure in elderly patients with stable COPD?
P
Population
Elderly patients (≥65 years) with stable chronic obstructive pulmonary disease (COPD) in primary care, without a previously confirmed diagnosis of heart failure
I
Intervention
Diagnostic model including history of ischaemic heart disease, laterally displaced apex beat, high body mass index, raised heart rate, NT-proBNP, and electrocardiography
O
Outcome
Independent diagnostic variables for concomitant heart failure (presence of heart failure determined by expert consensus panel)surrogate
A combination of simple clinical variables, NT-proBNP, and electrocardiography can effectively help primary care physicians identify unrecognised heart failure in elderly patients with stable COPD.
Limitations
- Selection bias due to low response rate (34%)
- Incorporation bias in consensus diagnosis due to the use of multiple tests for diagnosis
- Limited external validation of the final model for diagnostic accuracy.
- The final model and corresponding risk score need to be validated externally in a new sample of primary care patients with COPD
- Echocardiography was not evaluated for independent diagnostic value because it is not routinely available in primary care
Cite This Study
Rutten et al. (2005) conducted a cross-sectional in Chronic Obstructive Pulmonary Disease (n=405). Diagnostic evaluation including NT-proBNP and electrocardiography vs. No specific control group; diagnosis through clinical assessment and diagnostic tools was evaluated on New diagnosis of concomitant heart failure. A diagnostic evaluation using clinical history, physical examination, NT-proBNP, and electrocardiography identified concomitant heart failure in 20.5% of patients with stable COPD, with ROC area improved to 0.77 when NT-proBNP was added to the clinical model.