Recognising heart failure in elderly patients with stable chronic obstructive pulmonary disease in primary care: cross sectional diagnostic study
Abstract Objective To determine which clinical variables provide diagnostic information in recognising heart failure in primary care patients with stable chronic obstructive pulmonary disease (COPD) and whether easily available tests provide added diagnostic information. Design Cross sectional diagn...
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Published in | BMJ Vol. 331; no. 7529; pp. 1379 - 1382 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
London
British Medical Journal Publishing Group
10.12.2005
British Medical Association BMJ Publishing Group LTD BMJ Publishing Group BMJ Publishing Group Ltd |
Edition | International edition |
Subjects | |
Online Access | Get full text |
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Summary: | Abstract Objective To determine which clinical variables provide diagnostic information in recognising heart failure in primary care patients with stable chronic obstructive pulmonary disease (COPD) and whether easily available tests provide added diagnostic information. Design Cross sectional diagnostic study. Setting 51 primary care practices. Participants 1186 patients aged 65 years with COPD diagnosed by their general practitioner who did not have a diagnosis of heart failure confirmed by a cardiologist. Main outcome measures Independent diagnostic variables for concomitant heart failure in primary care patients with stable COPD. Results 405 patients (34% of eligible patients) underwent a systematic diagnostic investigation, which resulted in 83 (20.5%) receiving a new diagnosis of concomitant heart failure. Independent clinical variables for concomitant heart failure were a history of ischaemic heart disease, high body mass index, laterally displaced apex beat, and raised heart rate (area under the receiver operating characteristic curve (ROC area) 0.70, 95% confidence interval 0.64 to 0.76). Addition of measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) to the reduced “clinical model” had the largest added diagnostic value, with a significant increase of the ROC area to 0.77 (0.71 to 0.83), followed by electrocardiography (0.75, 0.69 to 0.81). C reactive protein and chest radiography had limited added value. A simplified diagnostic model consisting of the four independent clinical variables plus NT-proBNP and electrocardiography was developed. Conclusions A limited number of items easily available from history and physical examination, with addition of NT-proBNP and electrocardiography, can help general practitioners to identify concomitant heart failure in individual patients with stable COPD. |
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Bibliography: | local:bmj;331/7529/1379 href:bmj-331-1379.pdf istex:D963F821F80147D0C43F438DA3C0539A61E2BAC1 ArticleID:bmj.38664.661181.55 ark:/67375/NVC-JWFCBN71-D PMID:16321994 Correspondence to: F H Rutten ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Funding: Research grant (number 904-61-144) of the Netherlands Organisation for Scientific Research (NWO). Roche (Mannheim, Germany) supplied the assays for analysis of NT-proBNP. Ethical approval: Medical Ethical Committee of the University Medical Centre Utrecht, the Netherlands. We thank the participating patients, general practitioners and their assistants, including the general practices connected to the General Practice Network Utrecht (HNU), the cardiac sonographers Elly Lutgert-Hagman and Ineke Kasteleijn, the pulmonology technicians, especially Paul Munnik, and Pieter Zanen, lung physiologist. Frances Verheij assisted us with the data management. Contributors: FHR led the design of the study, collected the data, performed the statistical analysis, participated in the panel, and wrote the first draft of the paper. KGMM participated in the design of the study, the statistical analyses, and the writing of the paper. M-JMC supervised the echocardiography, participated in the reproducibility study and in the panel, and edited the paper. DEG helped to obtain funding, participated in the design of the study, and edited the paper. NPAZ participated in the statistical analyses and edited the paper. J-WJL supervised the pulmonary function tests, participated in obtaining funding and in the panel, and edited the paper. AWH initiated the research, secured funding, and participated in the study design, the statistical analyses, and the writing of the paper. AWH and FHR are guarantors. Correspondence to: F H Rutten F.H.Rutten@umcutrecht.nl Competing interests: None declared. |
ISSN: | 0959-8138 0959-8146 1468-5833 1756-1833 |
DOI: | 10.1136/bmj.38664.661181.55 |