Development and validation of a decision support tool for the diagnosis of acute heart failure: systematic review, meta- analysis, and modelling study

被引：39

作者：

Lee, Kuan Ken ^{[1
]}

Doudesis, Dimitrios ^{[1
,2
]}

Anwar, Mohamed ^{[1
]}

Astengo, Federica ^{[1
]}

Chenevier-Gobeaux, Camille ^{[3
]}

Claessens, Yann-Erick ^{[4
]}

Wussler, Desiree ^{[5
,6
]}

Kozhuharov, Nikola ^{[5
,7
]}

Strebel, Ivo ^{[5
]}

Sabti, Zaid ^{[5
]}

deFilippi, Christopher ^{[8
]}

Seliger, Stephen ^{[9
]}

Moe, Gordon ^{[10
]}

Fernando, Carlos ^{[10
]}

Bayes-Genis, Antoni ^{[11
]}

van Kimmenade, Roland R. J. ^{[12
]}

Pinto, Yigal ^{[13
]}

Gaggin, Hanna K. ^{[14
,15
]}

Wiemer, Jan C. ^{[16
]}

Moeckel, Martin ^{[17
]}

Rutten, Joost H. W. ^{[18
]}

van den Meiracker, Anton H. ^{[19
]}

Gargani, Luna ^{[20
]}

Pugliese, Nicola R. ^{[21
]}

Pemberton, Christopher ^{[22
]}

Ibrahim, Irwani ^{[23
]}

Gegenhuber, Alfons ^{[24
]}

Mueller, Thomas ^{[25
]}

Neumaier, Michael ^{[26
]}

Behnes, Michael ^{[27
]}

Akin, Ibrahim ^{[27
]}

Bombelli, Michele ^{[28
]}

Grassi, Guido ^{[29
]}

Nazerian, Peiman ^{[30
]}

Albano, Giovanni ^{[30
]}

Bahrmann, Philipp ^{[31
]}

Newby, David E. ^{[1
]}

Japp, Alan G. ^{[1
]}

Tsanas, Athanasios ^{[2
]}

Shah, Anoop S., V ^{[1
,32
]}

Richards, A. Mark ^{[22
,33
]}

McMurray, John J., V ^{[34
]}

Mueller, Christian ^{[5
]}

Januzzi, James L. ^{[14
,15
]}

Mills, Nicholas L. ^{[1
,2
]}

机构：

[1] Univ Edinburgh, British Heart Fdn Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland

[2] Univ Edinburgh, Usher Inst, Edinburgh, Midlothian, Scotland

[3] Cochin Hosp, Assistance Publ Hop Paris, Dept Biochem, Paris, France

[4] Princess Grace Hosp Ctr, Dept Emergency Med, Monaco, Monaco

[5] Univ Hosp Basel, Cardiovasc Res Inst Basel, Dept Cardiol, Basel, Switzerland

[6] Univ Basel, Univ Hosp Basel, Dept Internal Med, Basel, Switzerland

[7] Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England

[8] Inova Heart & Vasc Inst, Falls Church, VA USA

[9] Univ Maryland, Sch Med, Div Nephrol, Baltimore, MD 21201 USA

[10] Univ Toronto, St Michaels Hosp, Toronto, ON, Canada

[11] Hosp Univ Germans Trias Pujol, Heart Inst, CIBERCV, Badalona, Spain

[12] Radboud Univ Nijmegen, Dept Cardiol, Med Ctr, Nijmegen, Netherlands

[13] Univ Amsterdam, Amsterdam, Netherlands

[14] Harvard Med Sch, Boston, MA 02115 USA

[15] Massachusetts Gen Hosp, Div Cardiol, Boston, MA USA

[16] BRAHMS, Thermo Fisher Sci, Hennigsdorf, Germany

[17] Charite Univ Med Berlin, Dept Emergency & Acute Med, Chest Pain Units, Campus Mitte & Virchow, Berlin, Germany

[18] Radboud Univ Nijmegen, Dept Internal Med, Med Ctr, Nijmegen, Netherlands

[19] Erasmus MC, Dept Internal Med, Div Pharmacol & Vasc Med, Rotterdam, Netherlands

[20] Univ Pisa, Dept Surg Med & Mol Pathol & Crit Care Med, Pisa, Italy

[21] Univ Pisa, Dept Clin & Expt Med, Pisa, Italy

[22] Univ Otago, Christchurch Heart Inst, Christchurch, New Zealand

[23] Natl Univ Singapore Hosp, Emergency Med Dept, Singapore, Singapore

[24] Krankenhaus Bad Ischl, Dept Internal Med, Bad Ischl, Austria

[25] Hosp Voecklabruck, Dept Lab Med, Voecklabruck, Austria

[26] Heidelberg Univ, Univ Med Ctr Mannheim, Inst Clin Chem, Fac Med Mannheim, Mannheim, Germany

[27] Heidelberg Univ, Univ Med Ctr Mannheim, Fac Med Mannheim, Dept Med 1, Mannheim, Germany

[28] Univ Milano Bicocca, ASST Brianza, Pio Hosp Desio 11, Internal Med, Desio, Italy

[29] Univ Milano Bicocca, Clin Med, Milan, Italy

[30] Univ Careggi, Azienda Osped, Dept Emergency Med, Florence, Italy

[31] Heidelberg Univ, Univ Hosp Heidelberg, Dept Internal Med 3, Div Cardiol, Heidelberg, Germany

[32] London Sch Hyg & Tropical Med, London, England

[33] Natl Univ Heart Ctr Singapore, Cardiovasc Res Inst, Singapore, Singapore

[34] Univ Glasgow, British Heart Fdn Cardiovasc Res Ctr, Glasgow, Lanark, Scotland

来源：

BMJ-BRITISH MEDICAL JOURNAL | 2022年 / 377卷

基金：

英国医学研究理事会;

关键词：

BRAIN NATRIURETIC PEPTIDE; NT-PROBNP; EMERGENCY-DEPARTMENT; ACUTE DYSPNEA; DIFFERENTIAL-DIAGNOSIS; PERFORMANCE; PREDICTION; ECHOCARDIOGRAPHY; METAANALYSIS; DYSFUNCTION;

D O I：

10.1136/bmj-2021-068424

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES To evaluate the diagnostic performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds for acute heart failure and to develop and validate a decision support tool that combines NT-proBNP concentrations with clinical characteristics. DESIGN Individual patient level data meta-analysis and modelling study. SETTING Fourteen studies from 13 countries, including randomised controlled trials and prospective observational studies. PARTICIPANTS Individual patient level data for 10 369 patients with suspected acute heart failure were pooled for the meta-analysis to evaluate NT-proBNP thresholds. A decision support tool (Collaboration for the Diagnosis and Evaluation of Heart Failure (CoDE-HF)) that combines NT-proBNP with clinical variables to report the probability of acute heart failure for an individual patient was developed and validated. MAIN OUTCOME MEASURE Adjudicated diagnosis of acute heart failure. RESULTS Overall, 43.9% (4549/10 369) of patients had an adjudicated diagnosis of acute heart failure (73.3% (2286/3119) and 29.0% (1802/6208) in those with and without previous heart failure, respectively). The negative predictive value of the guideline recommended rule-out threshold of 300 pg/mL was 94.6% (95% confidence interval 91.9% to 96.4%); despite use of age specific rule-in thresholds, the positive predictive value varied at 61.0% (55.3% to 66.4%), 73.5% (62.3% to 82.3%), and 80.2% (70.9% to 87.1%), in patients aged <50 years, 50-75 years, and >75 years, respectively. Performance varied in most subgroups, particularly patients with obesity, renal impairment, or previous heart failure. CoDE-HF was well calibrated, with excellent discrimination in patients with and without previous heart failure (area under the receiver operator curve 0.846 (0.830 to 0.862) and 0.925 (0.919 to 0.932) and Brier scores of 0.130 and 0.099, respectively). In patients without previous heart failure, the diagnostic performance was consistent across all subgroups, with 40.3% (2502/6208) identified at low probability (negative predictive value of 98.6%, 97.8% to 99.1%) and 28.0% (1737/6208) at high probability (positive predictive value of 75.0%, 65.7% to 82.5%) of having acute heart failure. CONCLUSIONS In an international, collaborative evaluation of the diagnostic performance of NT-proBNP, guideline recommended thresholds to diagnose acute heart failure varied substantially in important patient subgroups. The CoDE-HF decision support tool incorporating NT-proBNP as a continuous measure and other clinical variables provides a more consistent, accurate, and individualised approach. STUDY REGISTRATION PROSPERO CRD42019159407.

引用

页数：15

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