title: Clinical evaluation of geriatric outpatients with suspected heart failure: value of symptoms, signs, and additional tests.
abstract: OBJECTIVE
  Heart failure (HF) is common in geriatric patients. Clinicians face diagnostic challenges primarily due to comorbidity and limited access to echocardiography. The purpose of this study was to identify independent determinants of the presence of HF in geriatric outpatients and to determine the optimal diagnostic strategy.
  
  
  RESULTS
  Geriatric outpatients [mean age 82 (±6) years, 30% men] with suspected HF underwent an extensive standardized diagnostic work-up. An expert consensus panel determined the presence of HF. Heart failure was present in 94 of 206 participants (46%). Male sex [odds ratio (OR) 2.0], age per 10 years (OR 1.6), nocturnal dyspnoea (OR 1.7), absence of wheezing (OR 2.1), loss of appetite (OR 1.7), and lower body mass index (BMI; OR 0.9) were independently associated with the presence of HF: the c-statistic of the model containing these items was 0.75. Of all additional tests, N-terminal pro-B-type natriuretic peptide (NT-proBNP) improved the diagnostic accuracy the most (OR ln NT-proBNP 2.8; c-statistic 0.92). A diagnostic rule, consisting of six clinical variables and NT-proBNP, showed good negative and positive predictive values.
  
  
  CONCLUSIONS
  Half of geriatric patients suspected of HF actually have HF. Apart from age, gender, and nocturnal dyspnoea, absence of wheezing, loss of appetite, and lower BMI were independently associated with the presence of HF. Symptoms and signs in combination with NT-proBNP reliably identified the presence or absence of HF in the vast majority of patients. Additional diagnostic tests, in particular echocardiography, can be targeted at those in whom the presence of HF remains uncertain and to ascertain the cause of HF.
authors.affiliation: Department of Geriatric Medicine, Elkerliek Hospital, Wesselmanlaan 25, Helmond, The Netherlands. irene@oudejans.info
authors.forename: Irène
authors.initials: I
authors.lastname: Oudejans
authors.forename: Arend
authors.initials: A
authors.lastname: Mosterd
authors.forename: Johanna A
authors.initials: JA
authors.lastname: Bloemen
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Valk
authors.forename: Edwin
authors.initials: E
authors.lastname: van Velzen
authors.forename: Jos P
authors.initials: JP
authors.lastname: Wielders
authors.forename: Nicolaas P
authors.initials: NP
authors.lastname: Zuithoff
authors.forename: Frans H
authors.initials: FH
authors.lastname: Rutten
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000032:analysis / Q000097:blood; D010446:Peptide Fragments / Q000032:analysis / Q000097:blood; D011379:Prognosis; D011498:Protein Precursors; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D014463:Ultrasonography
chemical_list: D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain