Primary care REFerral for EchocaRdiogram (REFER) in heart failure: a diagnostic accuracy study

Taylor, Clare; Roalfe, Andrea; Iles, Rachel; Hobbs, FD Richard; Barton, Pelham; Cowie, Martin R.; Davis, Russell; Deeks, Jonathan J; Mant, Jonathan; McCahon, Deborah; McDonagh, Theresa A.; Sutton, George C.; Tait, Lynda

doi:10.3399/bjgp16x688393

Cited by 34 publications

(39 citation statements)

References 30 publications

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“…However, the routine use of echocardiography in primary care setting is limited due to time, required expertise, and facilities 31. Serum natriuretic peptide tests continue to be used as a ‘rule out’ test to exclude heart failure in clinical practice, but reduced specificity and inconsistencies in optimal thresholds lead to misdiagnosis and inaccurate and expensive referrals from primary to secondary care 1, 2, 9, 32…”

Section: Discussionmentioning

confidence: 99%

A novel cardiac output response to stress test developed to improve diagnosis and monitoring of heart failure in primary care

et al. 2018

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AimsPrimary care physicians lack access to an objective cardiac function test. This study for the first time describes a novel cardiac output response to stress (CORS) test developed to improve diagnosis and monitoring of heart failure in primary care and investigates its reproducibility.Methods and resultsProspective observational study recruited 32 consecutive primary care patients (age, 63 ± 9 years; female, n = 18). Cardiac output was measured continuously using the bioreactance method in supine and standing positions and during two 3 min stages of a step‐exercise protocol (10 and 15 steps per minute) using a 15 cm height bench. The CORS test was performed on two occasions, i.e. Test 1 and Test 2. There was no significant difference between repeated measures of cardiac output and stroke volume at supine standing and Stage 1 and Stage 2 step exercises (all P > 0.3). There was a significant positive relationship between Test 1 and Test 2 cardiac outputs (r = 0.92, P = 0.01 with coefficient of variation of 7.1%). The mean difference in cardiac output (with upper and lower limits of agreement) between Test 1 and Test 2 was 0.1 (−1.9 to 2.1) L/min, combining supine, standing, and step‐exercise data.ConclusionsThe CORS, as a novel test for objective evaluation of cardiac function, demonstrates acceptable reproducibility and can potentially be implemented in primary care.

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Section: Discussionmentioning

confidence: 99%

A novel cardiac output response to stress test developed to improve diagnosis and monitoring of heart failure in primary care

et al. 2018

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“…Using a previously evaluated higher exclusionary cut-point of 400 pg/mL instead of 125 pg/mL,25 sensitivity and specificity in patients with AF were 73% (95% CI 61% to 82%), and 61% (95% CI 49% to 73%), respectively. PPVs and NPVs were 59% (95% CI 42% to 74%) and 75% (95% CI 61% to 86%), respectively.…”

Section: Resultsmentioning

confidence: 99%

“…We calculated the proportion of patients with an NTproBNP level below the 125 pg/mL cut-point and the prevalence of HF in this group. Additionally, we applied a higher cut-point of 400 pg/mL as recommended by the National Institute for Health and Care Excellence24 and previously evaluated against the ESC-recommended cut-point of 125 pg/mL 25. An alfa value of 0.05 was considered statistically significant.…”

Section: Methodsmentioning

confidence: 99%

Opportunistic screening for heart failure with natriuretic peptides in patients with atrial fibrillation: a meta-analysis of individual participant data of four screening studies

Doorn

Geersing

Kievit

et al. 2018

Heart

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“…20 This systematic review of clinical prediction rules in the diagnosis of chronic heart failure in the community used an extensive literature search and structured critical appraisal of the models using the guidance of the CHARMS checklist of the Cochrane collaboration. Four were externally validated, and one is undergoing a clinical impact study.…”

Section: Discussionmentioning

confidence: 99%

“…It was also noted that the current N-terminal proBNP (NT-proBNP) cut-off level of 400 pg/mL used in the UK is too high and means that one in five patients with heart failure may not be appropriately referred for further investigation and diagnosis. 20 This systematic review of clinical prediction rules in the diagnosis of chronic heart failure in the community used an extensive literature search and structured critical appraisal of the models using the guidance of the CHARMS checklist of the Cochrane collaboration. The validation cohort in this study is large compared with that used for the derivation of these rules.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of clinical prediction rules for the diagnosis of chronic heart failure

et al. 2019

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Aims This study sought to review the literature for clinical prediction models for the diagnosis of patients with chronic heart failure in the community and to validate the models in a novel cohort of patients with a suspected diagnosis of chronic heart failure. Methods and results MEDLINE and Embase were searched from 1946 to Q4 2017. Studies were eligible if they contained at least one multivariable model for the diagnosis of chronic heart failure applicable to the primary care setting. The CHARMS checklist was used to evaluate models. We also validated models, where possible, in a novel cohort of patients with a suspected diagnosis of heart failure referred to a rapid access diagnostic clinic. In total, 5310 articles were identified with nine articles subsequently meeting the eligibility criteria. Three models had undergone internal validation, and four had undergone external validation. No clinical impact studies have been completed to date. Area under the curve (AUC) varied from 0.74 to 0.93 and from 0.60 to 0.65 in the novel cohort for clinical models alone with AUC up to 0.89 in combination with electrocardiogram and B‐type natriuretic peptide (BNP). The AUC for BNP was 0.86 (95% confidence interval 83.3–88.6%). Conclusions This review demonstrates that there are a number of clinical prediction rules relevant to the diagnosis of chronic heart failure in the literature. Clinical impact studies are required to compare the use of clinical prediction rules and biomarker strategies in this setting.

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Primary care REFerral for EchocaRdiogram (REFER) in heart failure: a diagnostic accuracy study

Cited by 34 publications

References 30 publications

A novel cardiac output response to stress test developed to improve diagnosis and monitoring of heart failure in primary care

A novel cardiac output response to stress test developed to improve diagnosis and monitoring of heart failure in primary care

Opportunistic screening for heart failure with natriuretic peptides in patients with atrial fibrillation: a meta-analysis of individual participant data of four screening studies

A systematic review of clinical prediction rules for the diagnosis of chronic heart failure

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