Value of primary care electrocardiography for the prediction of left ventricular systolic dysfunction in patients with suspected heart failure

Lim, Tiong Keng; Collinson, Paul; Çelik, Esra Yaşar; Gaze, David; Senior, Roxy

doi:10.1016/j.ijcard.2006.01.012

Cited by 9 publications

(4 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, the cost of the test could account, in part, for the fact that 77% of Belgian patients with HF in primary care are already in NYHA stages III–IV at the time of HF diagnosis 19. To withhold ECG as a valuable diagnostic tool, repeated training of GPs to fine-tune their interpretation skills remains important 32. However, as quoted pertinently in our study, a negative ECG excludes HF, but the elderly rarely have a completely normal ECG 1 6.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

View full text Add to dashboard Cite

show abstract

“…It has been shown that an ECG can be used to pre‐screen for LVSD [14] when scored by a cardiology specialist. However, the measurement and interpretation of ECGs by primary‐care physicians compares poorly against ECGs conducted by cardiology specialists [30]. Because of this, we have limited our choice of ECG measures to those that are automatically reported on most commercially available ECG recorders, and hopefully therefore less susceptible to inter‐ and intra‐operator variability.…”

Section: Discussionmentioning

confidence: 99%

Screening for left ventricular systolic dysfunction in high‐risk patients in primary‐care: A cost‐benefit analysis

Goode

Clark

Bristow

et al. 2007

European J of Heart Fail

View full text Add to dashboard Cite

Background: Appropriate screening strategies are needed to cost effectively identify patients with undiagnosed and untreated left ventricular systolic dysfunction (LVSD). Aim: To investigate the cost-benefit of screening high-risk patients in primary-care for LVSD (EF b 40%) using various screening strategies. Methods: Patients considered at high-risk of developing LVSD were recruited from three primary-care practices. Patients with known LVSD were excluded. Echocardiography, electrocardiography and blood tests were performed blinded to an NT-proBNP result. Logistic regression (LR) and receiver-operating characteristic analysis were used to assess the univariate and multivariable utility of NT-proBNP, QRS duration, symptoms and evidence of myocardial infarction (MI) to detect LVSD. Results: 427 patients were assessed. 7.5% had undiagnosed LVSD. NT-proBNP, QRS, symptoms and MI were independent predictors of LVSD (p b 0.014) and the resultant LR-model had an area-under-the-curve of 0.89 (0.84-0.94) and specificity of 54% (51-79%) at a sensitivity of 100%. The LR-model avoided 24.1% (18.1-48.3%) of the cost and 50.1% (44.1-74.3%) of the echocardiograms compared to screening using echocardiography alone. Conclusions: Screening high-risk groups in primary-care increases the pick-up rate for undiagnosed LVSD and using an LR-model combining NT-proBNP, QRS, symptoms and evidence of MI has significant cost benefits.

show abstract

“…An entirely normal ECG also has a strong negative predictive value for heart failure. However, when comparing the diagnostic power of the ECG with BNP measurements, the ECG has been found to be inferior in routine clinical practice 36 38. If both tests are normal, heart failure is unlikely.…”

Section: Brain Natriuretic Peptide (Poc Wsas)mentioning

confidence: 99%

Best practice in primary care pathology: review 12

et al. 2010

View full text Add to dashboard Cite

This tenth best practice review examines four series of common primary care questions in laboratory medicine: (i) antenatal testing in pregnant women; (ii) estimated glomerular filtration rate calculation; (iii) safety testing for methotrexate; and (iv) blood glucose measurement in diabetes. The review is presented in question-answer format, referenced for each question series. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence-based. They will be updated periodically to take account of new information.

show abstract

Value of primary care electrocardiography for the prediction of left ventricular systolic dysfunction in patients with suspected heart failure

Cited by 9 publications

References 3 publications

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

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

Screening for left ventricular systolic dysfunction in high‐risk patients in primary‐care: A cost‐benefit analysis

Best practice in primary care pathology: review 12

Contact Info

Product

Resources

About