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

Verdú-Rotellar, José María; Frigola-Capell, Eva; Alvarez-Pérez, Rosa; Silva, Daniela da; Enjuanes, Cristina; Domingo, Mar; Mena, Amparo; Muñoz, Miguel Ángel

doi:10.1080/13814788.2017.1305104

Cited by 13 publications

(28 citation statements)

References 40 publications

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“…Sixty studies used medical record review as a reference standard. 22,23,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]42,43,45,46,49,50,54,55,[57][58][59][60][61][62][63]69,72, Twenty studies validated HF, 24,[28][29][30]33,43,46,54,59,65,67,77,82,83,85,88,[94][95][96]…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Fourteen studies validated secondary care EHRs 24,[28][29][30]33,43,54,59,65,67,77,83,85,88 and six studies validated primary care EHRs. 46,82,[94][95][96][97] Medical record review was used as the reference standard in all but three studies. 24,65,97 Heart Failure Validation Results…”

Section: Heart Failure Study Characteristicsmentioning

confidence: 99%

“…From the main validation result reported by each of the studies; sensitivity (available from nine studies)- 24,46,65,67,77,82,85,88,95 was ≥50% in six studies 46,77,82,85,88,95 but >66% (range 11-100%) in only one study, 46 PPV (19 studies) 24,[28][29][30]33,43,46,54,59,65,67,77,83,85,88,[94][95][96][97] was ≥80% (range 54-100%) in all but five studies, 29,67,94,96,97 specificity (three studies) 24,67,95 was ≥95% in all studies, and NPV (three studies) 24,67,95 was ≥84% (range 84-96%) in all studies.…”

Section: Overallmentioning

confidence: 99%

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<p>Validity of Acute Cardiovascular Outcome Diagnoses Recorded in European Electronic Health Records: A Systematic Review</p>

Davidson¹,

Banerjee²,

Muzambi³

et al. 2020

CLEP

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Background: Electronic health records are widely used in cardiovascular disease research. We appraised the validity of stroke, acute coronary syndrome and heart failure diagnoses in studies conducted using European electronic health records. Methods: Using a prespecified strategy, we systematically searched seven databases from dates of inception to April 2019. Two reviewers independently completed study selection, followed by partial parallel data extraction and risk of bias assessment. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value estimates were narratively synthesized and heterogeneity between sensitivity and PPV estimates were assessed using I 2. Results: We identified 81 studies, of which 20 validated heart failure diagnoses, 31 validated acute coronary syndrome diagnoses with 29 specifically recording estimates for myocardial infarction, and 41 validated stroke diagnoses. Few studies reported specificity or negative predictive value estimates. Sensitivity was ≤66% in all but one heart failure study, ≥80% for 91% of myocardial infarction studies, and ≥70% for 73% of stroke studies. PPV was ≥80% in 74% of heart failure, 88% of myocardial infarction, and 70% of stroke studies. PPV by stroke subtype was variable, at ≥80% for 80% of ischaemic stroke but only 44% of haemorrhagic stroke. There was considerable heterogeneity (I 2 >75%) between sensitivity and PPV estimates for all diagnoses. Conclusion: Overall, European electronic health record stroke, acute coronary syndrome and heart failure diagnoses are accurate for use in research, although validity estimates for heart failure and individual stroke subtypes were lower. Where possible, researchers should validate data before use or carefully interpret the results of previous validation studies for their own study purposes.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Heart Failure Study Characteristicsmentioning

confidence: 99%

Section: Overallmentioning

confidence: 99%

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<p>Validity of Acute Cardiovascular Outcome Diagnoses Recorded in European Electronic Health Records: A Systematic Review</p>

Davidson¹,

Banerjee²,

Muzambi³

et al. 2020

CLEP

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“…1) [12,13]. In everyday clinical practice, confirming or excluding HFpEF poses a considerable challenge with a potential for both overdiagnosis (mostly in primary care and in patients hospitalized for acute dyspnea) and underdiagnosis (especially in stable, uncongested, elderly patients with exertional symptoms) [14][15][16][17][18][19][20][21][22][23][24]. The abundance of HFpEF definitions might cause even more confusion among non-HF specialists.…”

Section: Introductionmentioning

confidence: 99%

On the search for the right definition of heart failure with preserved ejection fraction

et al. 2020

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The definition of heart failure with preserved ejection fraction (HFpEF) has evolved from a clinically based "diagnosis of exclusion" to definitions focused on objective evidence of diastolic dysfunction and/ /or elevated left ventricular filling pressures. Despite advances in our understanding of HFpEF pathophysiology and the development of more sophisticated imaging modalities, the diagnosis of HFpEF remains challenging, especially in the chronic setting, given that symptoms are provoked by exertion and diagnostic evaluation is largely conducted at rest. Invasive hemodynamic study, and in particularinvasive exercise testing, is considered the reference method for HFpEF diagnosis. However, its use is limited as opposed to the high number of patients with suspected HFpEF. Thus, diagnostic criteria for HFpEF should be principally based on non-invasive measurements. As no single non-invasive variable can adequately corroborate or refute the diagnosis, different combinations of clinical, echocardiographic, and/or biochemical parameters have been introduced. Recent years have brought an abundance of HF-pEF definitions. Here, we present and compare four of them: 1) the 2016 European Society of Cardiology criteria for HFpEF; 2) the 2016 echocardiographic algorithm for diagnosing diastolic dysfunction; 3) the 2018 evidence-based H 2 FPEF score; and 4) the most recent, 2019 Heart Failure Association HFA-PEFF algorithm. These definitions vary in their approach to diagnosis, as well as sensitivity and specificity. Further studies to validate and compare the diagnostic accuracy of HFpEF definitions are warranted. Nevertheless, it seems that the best HFpEF definition would originate from a randomized clinical trial showing a favorable effect of an intervention on prognosis in HFpEF.

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“…In Poland, echocardiography is still not a diagnostic procedure routinely available in primary care settings; therefore, the effort should be probably provided to more common use of natriuretic peptides diagnostic tests [ 6 , 7 ]. Taking into account the recently published data [ 16 ], some indirect evidence for a truly existing CHF in our patients may be history of cardiologic consultation—77% of the surveyed patients were consulted during the last year by the cardiologist. In addition, the reliability of the CHF diagnosis increase the ischaemic aetiology of CHF observed in most of our patients.…”

Section: Discussionmentioning

confidence: 99%

Chronic heart failure management in primary healthcare in Poland: Results of a nationwide cross-sectional study

Wizner

Fedyk-Łukasik

Opolski

et al. 2017

European Journal of General Practice

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Background: Organizational and educational activities in primary care in Poland have been introduced to improve the chronic heart failure (CHF) management. Objectives: To assess the use of diagnostic procedures, pharmacotherapy and referrals of CHF in primary care in Poland. Methods: The cross-sectional survey was conducted in 2013, involving 390 primary care centres randomly selected from a national database. Trained nurses contacted primary care physicians who retrospectively filled out the study questionnaires on the previous year’s CHF management in the last five patients who had recently visited their office. The data on diagnostic and treatment procedures were collected. Results: The mean age ± SD of the 2006 patients was 72 ± 11 years, 45% were female, and 56% had left ventricular ejection fraction <50%. The percentage of the CHF patients diagnosed based on echocardiography was 67% and significantly increased during the last decade. Echocardiography was still less frequently performed in older patients (≥80 years) than in the younger ones (respectively 50% versus 72%, Ρ <0.001) and in women than in men (62% versus 71%, P <0.001). The percentage of the patients treated with β-blocker alone was 88%, but those with a combination of angiotensin inhibition 71%. The decade before, these percentages were 68% and 57%, respectively. Moreover, an age-related gap observed in the use of the above-mentioned therapy has disappeared. Conclusion: The use of echocardiography in CHF diagnostics has significantly improved in primary care in Poland but a noticeable inequality in the geriatric patients and women remains. Most CHF patients received drug classes in accordance with guidelines.

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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

Cited by 13 publications

References 40 publications

<p>Validity of Acute Cardiovascular Outcome Diagnoses Recorded in European Electronic Health Records: A Systematic Review</p>

<p>Validity of Acute Cardiovascular Outcome Diagnoses Recorded in European Electronic Health Records: A Systematic Review</p>

On the search for the right definition of heart failure with preserved ejection fraction

Chronic heart failure management in primary healthcare in Poland: Results of a nationwide cross-sectional study

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