Recognising heart failure in elderly patients with stable chronic obstructive pulmonary disease in primary care: cross sectional diagnostic study.
OBJECTIVE
To determine which clinical variables provide diagnostic information in recognising heart failure in primary care patients with stable chronic obstructive pulmonary disease (COPD) and whether easily available tests provide added diagnostic information.


METHODS
Cross sectional diagnostic study.


METHODS
51 primary care practices.


METHODS
1186 patients aged > or = 65 years with COPD diagnosed by their general practitioner who did not have a diagnosis of heart failure confirmed by a cardiologist.


METHODS
Independent diagnostic variables for concomitant heart failure in primary care patients with stable COPD.


RESULTS
405 patients (34% of eligible patients) underwent a systematic diagnostic investigation, which resulted in 83 (20.5%) receiving a new diagnosis of concomitant heart failure. Independent clinical variables for concomitant heart failure were a history of ischaemic heart disease, high body mass index, laterally displaced apex beat, and raised heart rate (area under the receiver operating characteristic curve (ROC area) 0.70, 95% confidence interval 0.64 to 0.76). Addition of measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) to the reduced "clinical model" had the largest added diagnostic value, with a significant increase of the ROC area to 0.77 (0.71 to 0.83), followed by electrocardiography (0.75, 0.69 to 0.81). C reactive protein and chest radiography had limited added value. A simplified diagnostic model consisting of the four independent clinical variables plus NT-proBNP and electrocardiography was developed.


CONCLUSIONS
A limited number of items easily available from history and physical examination, with addition of NT-proBNP and electrocardiography, can help general practitioners to identify concomitant heart failure in individual patients with stable COPD.
Rutten
Frans H
FH
Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, 3508AB Netherlands. F.H.Rutten@umcutrecht.nl
Moons
Karel G M
KG
Cramer
Maarten-Jan M
MJ
Grobbee
Diederick E
DE
Zuithoff
Nicolaas P A
NP
Lammers
Jan-Willem J
JW
Hoes
Arno W
AW
D000368:Aged; D000553:Ambulatory Care; D003430:Cross-Sectional Studies; D004452:Echocardiography; D004562:Electrocardiography; D005194:Family Practice; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain