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[Diagnosis of heart failure with preserved or reduced ejection fraction in a one-stop clinic]
Rut Andrea1, Carlos Falces, Laura Sanchis
1Servicio de Cardiología, Instituto del Tórax, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IBIDAPS), Universidad de Barcelona, Barcelona, España. randrea@clinic.ub.es
Insights
A new one-stop heart failure (HF) clinic effectively diagnosed and characterized new onset heart failure patients, finding a high prevalence of HF with preserved ejection fraction (HF-PEF). A brain natriuretic peptide (BNP) cut-off of 60.12 pg/ml accurately identifies HF.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Diagnostics
Context:
- New onset heart failure (HF) diagnosis in outpatients presents challenges.
- A one-stop clinic model aims to streamline the diagnostic process.
- Understanding patient characteristics in HF with preserved ejection fraction (HF-PEF) versus HF with reduced ejection fraction (HF-REF) is crucial.
Purpose:
- To evaluate the utility of a one-stop clinic for diagnosing new onset heart failure (HF) in outpatients.
- To characterize patients with HF-PEF versus HF-REF.
- To establish a brain natriuretic peptide (BNP) cut-off for HF identification.
Summary:
- An observational study assessed 143 new onset HF outpatients in a one-stop clinic.
- The clinic diagnosed HF in 65.7%, with a higher prevalence of HF-PEF (67%).
- A BNP cut-off of 60.12 pg/ml demonstrated 83% sensitivity and 84% specificity for HF detection.
Impact:
- The one-stop clinic model is effective for diagnosing and characterizing new onset heart failure.
- Identified key predictors for HF-PEF (female gender, ankle swelling) and HF-REF (Q waves, higher BNP, heart rate).
- Established a validated BNP cut-off for improved HF diagnosis in primary care settings.
Objectives:
a) To assess the usefulness of a one-stop clinic for the diagnosis of outpatients with new onset heart failure; b) to characterize these patients comparing preserved (HF-PEF) versus reduced ejection fraction (HF-REF), and c) to determine brain natriuretic peptide (BNP) cut-off limit to identify HF in outpatients.
Design:
Observational descriptive study.
Setting:
Primary care.
Participants And Measurements:
A total of 143 outpatients with new onset HF were assessed in a one-stop clinic. A cardiologist evaluation, electrocardiogram, chest X-ray, BNP, and echocardiography (diastolic and systolic study) were performed.
Results:
Almost two-thirds (65.7%) were diagnosed with HF: 67% with HF-PEF and 33% HF-REF. Women (71.4% versus 38.7%, P=.002), presence of swelling ankles (61.9% versus 35.5%, P=.016) and higher body mass index (29.8±5.1 versus 27.2±5.0 P=.021) were more frequent in the first group of patients. Echocardiographic signs of diastolic dysfunction and pulmonary hypertension were found in both groups, with higher values of BNP (153.3±123.1 versus 400.8±579.8 P=.025) and troponin I (0.024±0.019 versus 0.071±0.12, P=.037) in HF-REF patients. Female gender and swelling ankles were predictors of HF-PEF in the multivariate analysis, while Q waves and higher values of BNP and heart rate were predictors of HF-REF. A cut-off value of 60.12 pg/ml for BNP provided 83% sensitivity, 84% specificity (AUC=0.898; 95% CI; 0.848-0.948; P <.001).
Conclusions:
The one-stop HF clinic has diagnosed and characterized outpatients with new onset HF and high prevalence of HF-PEF. The cut-off value of 60.12 pg/ml for BNP provides high sensitivity and specificity to identify HF in this population.
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