title: Early recognition of heart failure in patients with diabetes type 2 in primary care. A prospective diagnostic efficiency study. (UHFO-DM2).
abstract: BACKGROUND
  We hypothesize that the prevalence of unknown heart failure in diabetic patients aged 60 years and over is relatively high (15% or more) and that a cost-effective strategy can be developed to detect heart failure in these patients. The strategy is expected to include some signs and symptoms (such as dyspnoea, orthopnoea, pulmonary crepitations and laterally displaced apical beat), natriuretic peptide measurements (Amino-terminal B-type natriuretic peptide) and possibly electrocardiography. In a subset of patients straightforward echocardiography may show to be cost-effective. With information from our study the detection of previously unknown heart failure in diabetic patients could be improved and enable the physician to initiate beneficial morbidity and mortality reducing heart failure treatment more timely.
  
  
  OBJECTIVE
  - To assess the prevalence of (previously unrecognised) heart failure in primary care patients with diabetes type 2.- To establish the most cost-effective diagnostic strategy to detect unrecognised heart failure in these patients.
  
  
  OBJECTIVE
  - To assess the impact of heart failure, and the combination of a new diagnosis with accordingly treatment in patients with diabetes type 2 on health status.
  
  
  METHODS
  
  
  
  METHODS
  A prospective diagnostic efficiency study.
  
  
  METHODS
  Patients aged 60 years and older with diabetes type 2 from primary care, enlisted with the diabetes service of the Diagnostic Center in Etten-Leur (SHL)All participants will be investigated at the cardiology out-patient department of the regional hospital (Oosterschelde Hospital in Goes, Zeeland, the Netherlands) during a single 1.5 hour standardised diagnostic assessment, including history taking, physical examination, electrocardiography, echocardiography, blood tests, and Health status questionnaires. Patients will be asked if we can contact them afterwards for follow-up and for repeating the questionnaires after three and 12 months.Main study parameters/endpoints: Prevalence (with exact 95% confidence intervals) of (previously unrecognised) heart failure (systolic and 'isolated' diastolic) and the diagnostic value of signs and symptoms, NT-proBNP, electrocardiography and a combination of these items. The cost-effectiveness of different diagnostic strategies. Impact of heart failure and the combination of a new diagnosis with accordingly treatment on health status.
  
  
  BACKGROUND
  CCMO register NL2271704108.
authors.affiliation: Center for Diagnostic Support in Primary Care (SHL), Department of Scientific and Contract Research (WECOR), Bredaseweg 165, 4872 LA Etten-Leur, the Netherlands. l.boonman@shlbreda.nl
authors.forename: Leandra J M
authors.initials: LJ
authors.lastname: Boonman-de Winter
authors.forename: Frans H
authors.initials: FH
authors.lastname: Rutten
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Cramer
authors.forename: Anho H
authors.initials: AH
authors.lastname: Liem
authors.forename: Marcel J
authors.initials: MJ
authors.lastname: Landman
authors.forename: Henk F
authors.initials: HF
authors.lastname: van Stel
authors.forename: G Ardine
authors.initials: GA
authors.lastname: de Wit
authors.forename: Guy E H M
authors.initials: GE
authors.lastname: Rutten
authors.forename: Paulien A W
authors.initials: PA
authors.lastname: van Hessen
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003954:Diagnostic Services / Q000191:economics*; D042241:Early Diagnosis; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies