title: Applicability of current diagnostic algorithms in geriatric patients suspected of new, slow onset heart failure.
abstract: BACKGROUND
  referral for echocardiography for all geriatric outpatients suspected of heart failure (HF) is not feasible. Diagnostic algorithms could be helpful.
  
  
  OBJECTIVE
  to investigate whether available diagnostic algorithms accurately identify (older) patients (aged 70 years or over) eligible for echocardiography, with acceptable numbers of false-negatives.
  
  
  METHODS
  algorithms (European Society of Cardiology (ESC)) guideline, National Institute for Health and Clinical Excellence (NICE) guideline, multidisciplinary guideline the Netherlands (NL) and algorithm by Mant et al. were validated in 203 geriatric patients (mean age 82 ± 6 years, 30% men) suspected of new, slow onset HF. HF was adjudicated by an outcome panel. Applicability of algorithms was evaluated by calculating proportion of patients (i) referred for echocardiography, (ii) with HF among referred patients and (iii) without HF in the non-referred.
  
  
  RESULTS
  ninety-two (45%) patients had HF. Applying algorithms resulted in referral for echocardiography in 52% (normal NT-proBNP; ESC), 72% (normal ECG; ESC), 56% (NICE), 93% (NL) and 70% (Mant) of all patients, diagnosing HF in 78, 56, 76, 49 and 62% of those referred, respectively. In patients not referred for echocardiography HF was absent in 90, 82, 93, 100 and 95%, respectively.
  
  
  CONCLUSIONS
  the ESC NT-proBNP (<400 pg/ml)-based algorithm combines the lowest number of referrals for echocardiography (of whom 78% has HF) with a limited number (10%) of false negatives in the non-referred.
authors.affiliation: Department of Geriatric Medicine, Elkerliek Hospital, Helmond, Noord-Brabant, Netherlands. ioudejans@elkerliek.nl
authors.forename: Irène
authors.initials: I
authors.lastname: Oudejans
authors.forename: Arend
authors.initials: A
authors.lastname: Mosterd
authors.forename: Nicolaas P A
authors.initials: NP
authors.lastname: Zuithoff
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000465:Algorithms; D000553:Ambulatory Care; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D004452:Echocardiography; D004562:Electrocardiography; D005188:False Negative Reactions; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009426:Netherlands; D018579:Patient Selection; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D012017:Referral and Consultation; D015203:Reproducibility of Results; D013997:Time Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain