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Applicability of current diagnostic algorithms in geriatric patients suspected of new, slow onset heart failure
Irène Oudejans1, Arend Mosterd, Nicolaas P A Zuithoff
1Department of Geriatric Medicine, Elkerliek Hospital, Helmond, Noord-Brabant, Netherlands. ioudejans@elkerliek.nl
Insights
Diagnostic algorithms can help identify elderly patients needing echocardiography for heart failure (HF). The European Society of Cardiology (ESC) NT-proBNP algorithm offers efficient referral with few false negatives.
Area of Science:
- Geriatric Medicine
- Cardiology
- Diagnostic Medicine
Background:
- Referral for echocardiography in all geriatric outpatients with suspected heart failure (HF) is not practical.
- Diagnostic algorithms are needed to efficiently identify elderly patients requiring echocardiography.
Purpose of the Study:
- To evaluate the accuracy of existing diagnostic algorithms in identifying older patients (≥70 years) eligible for echocardiography.
- To assess the number of false-negative cases for HF in non-referred patients.
Main Methods:
- Validation of four algorithms (ESC, NICE, NL, Mant) in 203 geriatric patients (mean age 82 years) suspected of new, slow-onset HF.
- HF diagnosis was adjudicated by an expert panel.
- Evaluation of algorithm applicability based on referral rates, HF prevalence among referred, and absence of HF among non-referred patients.
Main Results:
- 45% of patients had HF.
- Referral rates varied by algorithm: ESC (NT-proBNP) 52%, ESC (ECG) 72%, NICE 56%, NL 93%, Mant 70%.
- HF was diagnosed in 78% of those referred by the ESC NT-proBNP algorithm; 10% of non-referred patients had HF.
Conclusions:
- The ESC NT-proBNP-based algorithm (<400 pg/ml) is effective for identifying geriatric patients with HF.
- This algorithm balances a low referral rate for echocardiography with a minimal false-negative rate (10%).
- It provides a feasible approach to managing suspected HF in older outpatients.
Background:
referral for echocardiography for all geriatric outpatients suspected of heart failure (HF) is not feasible. Diagnostic algorithms could be helpful.
Objective:
to investigate whether available diagnostic algorithms accurately identify (older) patients (aged 70 years or over) eligible for echocardiography, with acceptable numbers of false-negatives.
Methods:
algorithms (European Society of Cardiology (ESC)) guideline, National Institute for Health and Clinical Excellence (NICE) guideline, multidisciplinary guideline the Netherlands (NL) and algorithm by Mant et al. were validated in 203 geriatric patients (mean age 82 ± 6 years, 30% men) suspected of new, slow onset HF. HF was adjudicated by an outcome panel. Applicability of algorithms was evaluated by calculating proportion of patients (i) referred for echocardiography, (ii) with HF among referred patients and (iii) without HF in the non-referred.
Results:
ninety-two (45%) patients had HF. Applying algorithms resulted in referral for echocardiography in 52% (normal NT-proBNP; ESC), 72% (normal ECG; ESC), 56% (NICE), 93% (NL) and 70% (Mant) of all patients, diagnosing HF in 78, 56, 76, 49 and 62% of those referred, respectively. In patients not referred for echocardiography HF was absent in 90, 82, 93, 100 and 95%, respectively.
Conclusion:
the ESC NT-proBNP (<400 pg/ml)-based algorithm combines the lowest number of referrals for echocardiography (of whom 78% has HF) with a limited number (10%) of false negatives in the non-referred.
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