Prevalence and misdiagnosis of chronic heart failure in nursing home residents: the role of B-type natriuretic peptides

Abstract

Background/objectives. Without knowing the exact CHF prevalence, chronic heart failure (CHF) occurs frequently in elderly people both inside and outside nursing homes. For a diagnosis we have to rely on physical examination and additional tests. We therefore run the risk of missing CHF diagnoses or of diagnosing CHF when we should not. Natriuretic peptide assays have emerged as a diagnostic test but their use in nursing home residents is limited. We examined the number of misdiagnoses, the CHF prevalence and the role of natriuretic peptide. Method. Residents in one centre without aphasia, cognitive impairments or metastatic cancer were screened for CHF; the natriuretic peptide levels were measured separately.

Underestimated Prevalence of Chronic Heart Failure among Elderly Residing in Care Homes in Aruba

“…The high percentage of care home residents with previously unknown CHF (69% of all residents with CHF) proved in good agreement with the encountered 62% of previously unknown CHF in the afore-mentioned study in The Netherlands (2). Masking of CHF symptoms by co-morbidity, mild symptoms, and also unfamiliarity of general practitioners with the diagnostic value of the BNP may explain the underestimation.…”

“…However, BNP is less often used in care homes, because co-morbidity, a widespread characteristic of its residents, complicates the interpretation of the BNP outcomes (2). For example, misinterpretation may be caused by renal dysfunction, acute coronary syndrome, pulmonary embolism, obesity, age, gender and critical illness.…”

“…In addition, signs and symptoms of CHF in residents are often obscured by physical and psychological disabilities. These render CHF diagnosis difficult and were found to contribute to the observed underestimation of CHF in Dutch community-dwelling elderly and residents (2).…”

Neurohormonal profile of patients with heart failure and diabetes

“…These data in HF patients with diabetes further establish the important role of these natriuretic peptides in (suspected) HF. 29 n references…”

B‐Type Natriuretic Peptide–Directed Ultrafiltration Improves Care in Acutely Hospitalized Dialysis Patients

“…Our findings of detecting occult CHF is consistent with others' findings when comparing the detection sensitivity of a biomarker with physical examination. 13 Physical examination is not only inadequate for the detection of volume overload, but it is also unable to accurately detect volume depletion. 14 Some previous studies have questioned the validity of BNP utilization in ESRD [15][16][17] and found ''no correlation between the plasma levels of BNP and body weight changes during HD.''…”