Validation of heart failure diagnosis registered in primary care records in two primary care centres in Barcelona (Spain) and factors related. A cross-sectional study.

BACKGROUND: Heart failure (HF) diagnosis as reported in primary care medical records is not always properly confirmed and could result in over-registration. OBJECTIVES: To determine the proportion of registered HF that can be confirmed with information from primary care medical records and to analyse related factors. METHODS: A cross-sectional study. The medical records of 595 HF patients attended in two primary healthcare centres in Barcelona (Spain) were revised and validated by a team of experts who classified diagnosis into confirmed, unconfirmed, and misdiagnosis. Variables potentially related to the confirmation of the diagnosis were analysed. The revision of medical records and data collection took place from 15 January to 31 March 2014. RESULTS: Mean (standard deviation) age was 78 (10) years and 58% were women. The diagnosis could be confirmed in 53.6% of patients. Factors associated with a greater probability of having a confirmed diagnosis were age (yearly OR: 0.97, 95%CI: 0.95-0.99), cardiologist follow-up (OR: 3.66, 95%CI: 2.46-5.48), history of ischaemic heart disease (OR: 2.18, 95%CI: 1.36-2.48), atrial fibrillation (OR: 2.01, 95%CI: 1.34-3.03), and prescription of loop diuretics (OR: 3.24, 95%CI: 2.14-4.89). CONCLUSION: Only in half of the patients labelled as HF in primary care medical records could this diagnosis be further confirmed. Variables regularly registered in clinical practice could help general practitioners identify those patients requiring a revision of their HF diagnosis.

Punto de corte óptimo de NT-proBNP para el diagnóstico de insuficiencia cardiaca mediante un test de determinación rápida en atención primaria / Rapid point-of-care NT-proBNP optimal cut-off point for heart failure diagnosis in primary care

Introducción y objetivos. La determinación de péptidos natriuréticos puede estar recomendada como paso previo al ecocardiograma ante la sospecha de insuficiencia cardiaca. El punto de corte óptimo para el diagnóstico de insuficiencia cardiaca en atención primaria no está completamente definido. El objetivo es determinar dicho punto de corte. Métodos. Es un estudio prospectivo para evaluar un test rápido local de fracción N-terminal del péptido natriurético tipo B en atención primaria. Se incluyó a pacientes con solicitud de ecocardiograma realizada por un médico de familia ante la sospecha clínica de insuficiencia cardiaca. Se realizó historia clínica y exploración física basadas en los criterios de Framingham, electrocardiograma, radiografía de tórax, determinación de fracción N-terminal del péptido natriurético tipo B y ecocardiograma. El diagnóstico de insuficiencia cardiaca fue establecido por un cardiólogo ciego al valor de fracción N-terminal del péptido natriurético tipo B, utilizando los criterios de la Sociedad Europea de Cardiología (clínica y confirmación ecocardiográfica). Resultados. Se evaluó a 220 pacientes (el 65,5% mujeres) con una mediana [intervalo intercuartílico] de edad de 74 [67-81] años. El diagnóstico de insuficiencia cardiaca se confirmó en 52 (23,6%), 16 con fracción de eyección del ventrículo izquierdo < 50% (39,6 ± 5,1%). Los valores de fracción N-terminal del péptido natriurético tipo B fueron 715 [510,5-1.575] y 77,5 [58-179,75] pg/ml para pacientes con y sin insuficiencia cardiaca respectivamente. El mejor punto de corte fue 280 pg/ml, con un área bajo la curva receiver operating characteristic de 0,94 (intervalo de confianza del 95%, 0,91-0,97). Seis pacientes diagnosticados de insuficiencia cardiaca (11,5%) tuvieron valores de fracción N-terminal del péptido natriurético tipo B < 400 pg/ml. La incorporación de los péptidos habría evitado el 67% de los ecocardiogramas solicitados. Conclusiones. En una población ambulatoria atendida en atención primaria, el mejor punto de corte de fracción N-terminal del péptido natriurético tipo B para descartar insuficiencia cardiaca fue 280 pg/ml. La determinación de fracción N-terminal del péptido natriurético tipo B mejora los procesos diagnósticos y podría ser coste-efectiva (AU)

Introduction and objectives. Measurement of natriuretic peptides may be recommended prior to echocardiography in patients with suspected heart failure. Cut-off point for heart failure diagnosis in primary care is not well established. We aimed to assess the optimal diagnostic cut-off value of N-terminal pro-B-type natriuretic peptide on a community population attended in primary care. Methods. Prospective diagnostic accuracy study of a rapid point-of-care N-terminal pro-B-type natriuretic peptide test in a primary healthcare centre. Consecutive patients referred by their general practitioners to echocardiography due to suspected heart failure were included. Clinical history and physical examination based on Framingham criteria, electrocardiogram, chest X-ray, N-terminal pro-B-type natriuretic peptide measurement and echocardiogram were performed. Heart failure diagnosis was made by a cardiologist blinded to N-terminal pro-B-type natriuretic peptide value, using the European Society of Cardiology diagnosis criteria (clinical and echocardiographic data). Results. Of 220 patients evaluated (65.5% women; median 74 years [interquartile range 67-81]). Heart failure diagnosis was confirmed in 52 patients (23.6%), 16 (30.8%) with left ventricular ejection fraction <50% (39.6 [5.1]%). Median values of N-terminal pro-B-type natriuretic peptide were 715 pg/mL [interquartile range 510.5-1575] and 77.5 pg/mL [interquartile range 58-179.75] for patients with and without heart failure respectively. The best cut-off point was 280 pg/mL, with a receiver operating characteristic curve of 0.94 (95% confidence interval, 0.91-0.97). Six patients with heart failure diagnosis (11.5%) had N-terminal pro-B-type natriuretic peptide values <400 pg/mL. Measurement of natriuretic peptides would avoid 67% of requested echocardiograms. Conclusions. In a community population attended in primary care, the best cut-off point of N-terminal pro-B-type natriuretic peptide to rule out heart failure was 280 pg/mL. N-terminal pro-B-type natriuretic peptide measurement improve work-out diagnosys and could be cost-effectiveness (AU)

Rapid point-of-care NT-proBNP optimal cut-off point for heart failure diagnosis in primary care.

INTRODUCTION AND OBJECTIVES: Measurement of natriuretic peptides may be recommended prior to echocardiography in patients with suspected heart failure. Cut-off point for heart failure diagnosis in primary care is not well established. We aimed to assess the optimal diagnostic cut-off value of N-terminal pro-B-type natriuretic peptide on a community population attended in primary care. METHODS: Prospective diagnostic accuracy study of a rapid point-of-care N-terminal pro-B-type natriuretic peptide test in a primary healthcare centre. Consecutive patients referred by their general practitioners to echocardiography due to suspected heart failure were included. Clinical history and physical examination based on Framingham criteria, electrocardiogram, chest X-ray, N-terminal pro-B-type natriuretic peptide measurement and echocardiogram were performed. Heart failure diagnosis was made by a cardiologist blinded to N-terminal pro-B-type natriuretic peptide value, using the European Society of Cardiology diagnosis criteria (clinical and echocardiographic data). RESULTS: Of 220 patients evaluated (65.5% women; median 74 years [interquartile range 67-81]). Heart failure diagnosis was confirmed in 52 patients (23.6%), 16 (30.8%) with left ventricular ejection fraction <50% (39.6 [5.1]%). Median values of N-terminal pro-B-type natriuretic peptide were 715 pg/mL [interquartile range 510.5-1575] and 77.5 pg/mL [interquartile range 58-179.75] for patients with and without heart failure respectively. The best cut-off point was 280 pg/mL, with a receiver operating characteristic curve of 0.94 (95% confidence interval, 0.91-0.97). Six patients with heart failure diagnosis (11.5%) had N-terminal pro-B-type natriuretic peptide values <400 pg/mL. Measurement of natriuretic peptides would avoid 67% of requested echocardiograms. CONCLUSIONS: In a community population attended in primary care, the best cut-off point of N-terminal pro-B-type natriuretic peptide to rule out heart failure was 280 pg/mL. N-terminal pro-B-type natriuretic peptide measurement improve work-out diagnoses and could be cost-effectiveness.