Primary care REFerral for EchocaRdiogram (REFER) in heart failure: diagnostic accuracy study

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Primary care REFerral for EchocaRdiogram (REFER) in heart failure: diagnostic accuracy study. / McCahon, Deborah; Taylor, CJ; Iles, Rachel; Hobbs, F D Richard; Barton, Pelham; Cowie, Martin R; Davis, Russell C.; Deeks, Jonathan; McDonagh, Theresa; Mant, Jonathan; Tait, L.

In: British Journal of General Practice , 21.09.2016.

Research output: Contribution to journalArticlepeer-review

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APA

McCahon, D., Taylor, CJ., Iles, R., Hobbs, F. D. R., Barton, P., Cowie, M. R., Davis, R. C., Deeks, J., McDonagh, T., Mant, J., & Tait, L. (Accepted/In press). Primary care REFerral for EchocaRdiogram (REFER) in heart failure: diagnostic accuracy study. British Journal of General Practice .

Vancouver

Author

McCahon, Deborah ; Taylor, CJ ; Iles, Rachel ; Hobbs, F D Richard ; Barton, Pelham ; Cowie, Martin R ; Davis, Russell C. ; Deeks, Jonathan ; McDonagh, Theresa ; Mant, Jonathan ; Tait, L. / Primary care REFerral for EchocaRdiogram (REFER) in heart failure: diagnostic accuracy study. In: British Journal of General Practice . 2016.

Bibtex

@article{783fc40c69054f2793b2417023b8dc36,
title = "Primary care REFerral for EchocaRdiogram (REFER) in heart failure: diagnostic accuracy study",
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 over 55 years, presenting with shortness of breath, lethargy or ankle oedema from 28 general practices in England. Method: 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: 304 participants were recruited. 104 (34.2% (95% CI 28.9 to 39.8)) had 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% (38.5% to 52.7%). NT-proBNP level alone with a cut-off less than 400pg/ml, had sensitivity 76.9% (67.6% to 84.6%) and specificity 91.5% (86.7% to 95.0%). At the lower cut-off of NT-proBNP <125pg/ml, sensitivity was 94.2% (95% CI 87.9% to 97.9%) and specificity 49.0% (41.9% to 56.1%). Conclusions: At the low threshold of NT-proBNP<125pg/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 400pg/ml may mean more than one in five patients with heart failure is not appropriately referred. Guideline natriuretic peptide thresholds may need to be revised. ",
author = "Deborah McCahon and CJ Taylor and Rachel Iles and Hobbs, {F D Richard} and Pelham Barton and Cowie, {Martin R} and Davis, {Russell C.} and Jonathan Deeks and Theresa McDonagh and Jonathan Mant and L Tait",
year = "2016",
month = sep,
day = "21",
language = "English",
journal = "British Journal of General Practice ",
issn = "0960-1643",
publisher = "Royal College of General Practitioners",

}

RIS

TY - JOUR

T1 - Primary care REFerral for EchocaRdiogram (REFER) in heart failure: diagnostic accuracy study

AU - McCahon, Deborah

AU - Taylor, CJ

AU - Iles, Rachel

AU - Hobbs, F D Richard

AU - Barton, Pelham

AU - Cowie, Martin R

AU - Davis, Russell C.

AU - Deeks, Jonathan

AU - McDonagh, Theresa

AU - Mant, Jonathan

AU - Tait, L

PY - 2016/9/21

Y1 - 2016/9/21

N2 - 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 over 55 years, presenting with shortness of breath, lethargy or ankle oedema from 28 general practices in England. Method: 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: 304 participants were recruited. 104 (34.2% (95% CI 28.9 to 39.8)) had 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% (38.5% to 52.7%). NT-proBNP level alone with a cut-off less than 400pg/ml, had sensitivity 76.9% (67.6% to 84.6%) and specificity 91.5% (86.7% to 95.0%). At the lower cut-off of NT-proBNP <125pg/ml, sensitivity was 94.2% (95% CI 87.9% to 97.9%) and specificity 49.0% (41.9% to 56.1%). Conclusions: At the low threshold of NT-proBNP<125pg/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 400pg/ml may mean more than one in five patients with heart failure is not appropriately referred. Guideline natriuretic peptide thresholds may need to be revised.

AB - 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 over 55 years, presenting with shortness of breath, lethargy or ankle oedema from 28 general practices in England. Method: 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: 304 participants were recruited. 104 (34.2% (95% CI 28.9 to 39.8)) had 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% (38.5% to 52.7%). NT-proBNP level alone with a cut-off less than 400pg/ml, had sensitivity 76.9% (67.6% to 84.6%) and specificity 91.5% (86.7% to 95.0%). At the lower cut-off of NT-proBNP <125pg/ml, sensitivity was 94.2% (95% CI 87.9% to 97.9%) and specificity 49.0% (41.9% to 56.1%). Conclusions: At the low threshold of NT-proBNP<125pg/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 400pg/ml may mean more than one in five patients with heart failure is not appropriately referred. Guideline natriuretic peptide thresholds may need to be revised.

M3 - Article

JO - British Journal of General Practice

JF - British Journal of General Practice

SN - 0960-1643

ER -