General practitioners' judgement of chronic heart failure in the oldest old: Insights from the BELFRAIL study

被引:6
作者
Smeets, Miek [1 ]
Degryse, Jan [1 ,2 ]
Aertgeerts, Bert [1 ]
Janssens, Stefan [3 ]
Adriaensen, Wim [1 ,2 ]
Mathei, Catharina [1 ]
Van Pottelbergh, Gijs [1 ,4 ]
Wallemacq, Pierre [5 ]
Vanoverschelde, Jean-Louis [6 ]
Vaes, Bert [1 ,2 ]
机构
[1] KU Leuven KUL, Dept Publ Hlth & Primary Care, Leuven, Belgium
[2] UCL, Inst Hlth & Soc, Brussels, Belgium
[3] KU Leuven KUL, Univ Ziekenhuis Gasthuisberg, Dept Cardiovasc Dis, Leuven, Belgium
[4] Leuven Univ Coll, Dept Hlth & Technol, Leuven, Belgium
[5] UCL, Clin Univ St Luc, Lab Analyt Biochem, Brussels, Belgium
[6] UCL, Clin Univ St Luc, Dept Cardiol, Brussels, Belgium
关键词
Heart failure; General practice; Diagnosis; Mortality; Aged; 80 and over; TASK-FORCE; DOPPLER-ECHOCARDIOGRAPHY; VENTRICULAR DYSFUNCTION; NATRIURETIC PEPTIDES; CARDIAC DYSFUNCTION; EUROPEAN-SOCIETY; PRIMARY-CARE; PREVALENCE; RECOMMENDATIONS; DIAGNOSIS;
D O I
10.1016/j.ijcard.2015.05.002
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background and objectives: Conflicting evidence exists about the value of general practitioners' (GPs') diagnoses of chronic heart failure (CHF), especially in older persons. Therefore, the relationship between GPs' judgement of CHF and objective cardiac abnormalities and their respective prognostic value for 5-year mortality in patients aged 80 and older was studied. Methods and results: These analyses were embedded within the prospective, population-based BELFRAIL study. At baseline, 525 patients (mean age 85 +/- 3.7 years, 37% men) were clinically assessed by their GPs, had NT-proBNP levels determined and received a detailed echocardiography at home. GPs were asked to judge the presence of CHF and to list their arguments in favour or against CHF. Cause-specific mortality was collected until 5.2 +/- 0.25 years after baseline. GPs suspected CHF in 154 patients (29%). The prevalence of objective cardiac abnormalities was 35% (n = 183). GPs' judgement predicted objective cardiac abnormalities inaccurately (sensitivity 45% (95% CI 38-53), specificity 79% (95% CI 75-83)). However, both objective cardiac abnormalities and GPs' diagnoses of CHF were good predictors of 5-year mortality (HR 2.1 (95% CI 1.6-2.7) vs 1.7 (95% CI 1.3-2.3), respectively). Furthermore, the presence of objective cardiac abnormalities was not significantly better than GPs' judgement in identifying patients at risk for mortality, although a trend for better cardiovascular mortality risk classification was noted (NRI 10% (95% CI - 2 to 21%), P = 0.13). Conclusions: Although GPs' judgement of CHF and objective cardiac abnormalities correlated poorly, the validity of GPs' clinical judgement for mortality risk stratification was demonstrated. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:120 / 127
页数:8
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