Diagnostic rules and algorithms for the diagnosis of non-acute heart failure in patients 80 years of age and older: a diagnostic accuracy and validation study

Smeets, Miek; Degryse, Jean-Marie; Janssens, Stefan; Matheï, Catharina; Wallemacq, Pierre; Vanoverschelde, Jean–Louis; Aertgeerts, Bert; Vaes, Bert

doi:10.1136/bmjopen-2016-012888

Cited by 6 publications

(7 citation statements)

References 31 publications

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“…Among 259 patients with elevated NT-proBNP who underwent echocardiogram, HF was present in only 68, so that as high as 73.7% of the referrals for echocardiogram could be considered as not necessary. 29 The 97.5% quantile levels identified in our sample of asymptomatic older adults with an optimal profile with respect to NT-proBNP predictors for those ≥70 were all above the recommended cut-offs. Recent data coming from the NT-proBNP reference values in older adults ICON-RELOADED Study, which aimed to validate the age-specific NT-proBNP cut-offs for rule-in of 450, 900, and 1800 ng/L for ages <50, 50 to 75, and 75 years, showed the least best performance with respect to sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio precisely among those with 75 years and older.…”

Section: Discussionmentioning

confidence: 59%

“…However, the specificity was as low as 34%. Among 259 patients with elevated NT‐proBNP who underwent echocardiogram, HF was present in only 68, so that as high as 73.7% of the referrals for echocardiogram could be considered as not necessary 29 . The 97.5% quantile levels identified in our sample of asymptomatic older adults with an optimal profile with respect to NT‐proBNP predictors for those ≥70 were all above the recommended cut‐offs.…”

Section: Discussionmentioning

confidence: 72%

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N‐terminal pro brain natriuretic peptide reference values in community‐dwelling older adults

et al. 2022

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Aims Available upper reference levels (URLs) in older adults for N-terminal pro brain natriuretic peptide (NT-proBNP), an established biomarker for heart failure, are mainly based on small samples. We aimed to identify NT-proBNP URL in a population-based reference sample of individuals aged ≥65 years. Methods and resultsWe analysed established NT-proBNP predictors using quantile regression among 2459 participants of two-independent population-based cohorts located in Germany, the Activity and Function in the Elderly Study (ActiFE, n = 1450) and the Study of Health in Pomerania (SHIP-TREND-0, n = 1009). Based on predictors a reference population of 441 subjects (ActiFE, n = 227; SHIP-TREND-0, n = 214) without history of diabetes, cardiovascular, or pulmonary diseases and with systolic blood pressure (BP) <140 mmHg, diastolic BP ≥60 and ≤90 mmHg, haemoglobin in men ≥14 and ≤18 g/dL and in women ≥12 and ≤16 g/dL, GFR ≥60 mL/min/1.73 m 2 , CRP <5 mg/L, BMI ≥18 and ≤33 kg/m 2 , and hs-cTnI <40 ng/L were built with NT-proBNP median levels and 97.5% quantiles reported stratified by sex and age. In a secondary analysis the URL among 97 SHIP-TREND-0 participants with a left ventricular ejection fraction (LVEF) ≥50 and no diastolic dysfunction were estimated. The median age in the identified reference sample was 70 years, with 41.9% and 40.2% male participants in ActiFE and SHIP-TREND-0, respectively. We observed an age-dependent increment of NT-proBNP levels with higher values in women compared to men. Notably, NT-proBNP levels were >125 ng/L in 165 participants (37.4%), with NT-proBNP URL (97.5% quantiles) equal to 663, 824, 592, and 697 ng/L in men, and 343, 463, 2641, 1276 ng/L in women for ages 65-69, 70-74, 75-79, and 80+ years, respectively. In the secondary analysis with a LVEF ≥50 and no diastolic dysfunction (35 men and 62 women) NT-proBNP levels >125 ng/L were still observed in 38 (39.2%) participants. Conclusions This reference sample of apparently healthy asymptomatic older adults showed an age-related increment of NT-proBNP levels with URL markedly higher than the European Society of Cardiology recommended cut-off of 125 ng/L for the diagnosis of heart failure in ambulatory settings. Identifying URL in those ≥80 years remains complex. Our results attempt to provide a frame for the further investigation of age-specific NT-proBNP cut-offs in older adults. Considering the demographic changes, further evaluation of NT-proBNP URL in larger samples of older adults followed by the validation of age-specific cut-off values for the identification of heart failure in those 65 years or older are urgently needed.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 72%

N‐terminal pro brain natriuretic peptide reference values in community‐dwelling older adults

et al. 2022

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“…This is an issue that HF guideline developers should consider 1 18. NT-proBNP could support GPs in this risk stratification, as it provides prognostic information in cardiac outpatients 1 3 20 28 29. Additionally, in our study, the concepts of HFrEF and HFpEF were cited by very few GPs.…”

Section: Discussionmentioning

confidence: 76%

“…The paradigm shift to an earlier risk assessment should be more widely disseminated in practice. However, access to natriuretic peptides is indispensable to achieve this 1 22 28 29. The main modifiable barrier for further investigations in this study is not, as formerly described, a lack of access or a pure lack of knowledge.…”

Section: Discussionmentioning

confidence: 79%

Think-aloud study about the diagnosis of chronic heart failure in Belgian general practice

et al. 2019

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ObjectivesDiagnosing chronic heart failure (CHF) in general practice is challenging. Our aim was to investigate how general practitioners (GPs) diagnose CHF in real-world patients.DesignThink-aloud study.MethodsFourteen GPs were asked to reason about four real-world CHF cases from their own practices. The cases were selected through a clinical audit. This was followed by an interview to get a deeper insight in their reasoning. The Qualitative Analysis Guide of Leuven was used as a guide in data analysis.ResultsWe developed a conceptual diagnostic model based on three important reasoning steps. First, GPs assessed the likelihood of CHF based on the presence or absence of HF signs and symptoms. However, this approach had serious limitations since GPs experienced many barriers in their clinical assessment, especially in comorbid elderly. Second, if CHF was considered based on step 1, the main influencing factor to take further diagnostic steps was the GPs’ perception of the added value of a validated CHF diagnosis in that specific case. Third, the choice and implications of these further diagnostic steps (N-terminal pro B-type natriuretic peptide, ECG and/or cardiac ultrasound) were influenced by the GPs’ knowledge about these tests and the quality of the cardiologists’ reports.ConclusionThis think-aloud study identified the factors that influenced the diagnostic reasoning about CHF in general practice. As a consequence, targets to improve this diagnostic reasoning were withheld: a paradigm shift towards an earlier and more comprehensive risk assessment with, among others, access to natriuretic peptide testing and convincing GPs of the added value of a validated HF diagnosis.

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“…For each CV that was obtained by the 3 methods, we classified subjects as having high values (high physical fitness group: High Group) or low values (low physical fitness group: Low Group), and we developed a cumulative CLTC curve using the Kaplan-Meier method [17]. We analyzed the differences between the cumulative CLTC curves for the High and Low Groups with the log rank test.…”

Section: Methodsmentioning

confidence: 99%

Fitness Age Score and the Risk of Long-Term Care Insurance Certification—The Kyoto-Kameoka Longitudinal Study

Yoshida¹,

Kimura²,

Yamada³

et al. 2017

OJEpi

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Long-Term Care Insurance System has been introduced to provide appropriate care for the elderly who needs nursing care in Japan. Physical function is one of most important function for the elderly to live independently. A previous study had established a Fitness Age Score (FAS) based on a theory for biomarker of aging. This study clarified whether the FAS could be used to predict the need for certification of long-term care (CLTC) in independent elderly people. We included 939 independent, community-dwelling-elderly (average age, 74.4 years) whose physical function was measured and for whom the CLTC was tracked for 24 months. The FAS comprised five physical fitness items: Walking time, grip strength, one-leg standing, vertical jump, and functional reach test. Based on the FAS, we calculated the odds ratio (OR) for the CLTC. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) was used for further analysis. We also used the Youden Index (YI), minimum distance method (MD), and two-graph ROC method (TG) to calculate cutoff values (CVs) for screening. We divided subjects into the low and high physical fitness group with CVs. We developed cumulative CLTC curves using the Kaplan-Meier method. Sixteen people could not be tracked for the full 24 months. The measurement of FAS was completed for 798 people, of whom 28 became CLTC. The measurement of FAS was not completed for 125 people, of whom 21 became CLTC. The CLTC OR for people 191with incomplete FAS was 5.553. The AUC was 0.72 (p < 0.001). The CVs for the FAS were −0.29 for YI (sensitivity, 92.9% and specificity, 40.4%), −1.23 for MD (57.1% and 73.4%), and −0.81 for TG (60.7% and 60.9%). The cumulative CLTC curves according to CVs all showed significant differences (p = 0.000 -0.020). In conclusion, the FAS can be used to predict CLTC.

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Diagnostic rules and algorithms for the diagnosis of non-acute heart failure in patients 80 years of age and older: a diagnostic accuracy and validation study

Cited by 6 publications

References 31 publications

N‐terminal pro brain natriuretic peptide reference values in community‐dwelling older adults

N‐terminal pro brain natriuretic peptide reference values in community‐dwelling older adults

Think-aloud study about the diagnosis of chronic heart failure in Belgian general practice

Fitness Age Score and the Risk of Long-Term Care Insurance Certification—The Kyoto-Kameoka Longitudinal Study

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