title: [Diagnosis of heart failure with preserved or reduced ejection fraction in a one-stop clinic].
abstract: OBJECTIVE
  a) To assess the usefulness of a one-stop clinic for the diagnosis of outpatients with new onset heart failure; b) to characterize these patients comparing preserved (HF-PEF) versus reduced ejection fraction (HF-REF), and c) to determine brain natriuretic peptide (BNP) cut-off limit to identify HF in outpatients.
  
  
  METHODS
  Observational descriptive study.
  
  
  METHODS
  Primary care.
  
  
  METHODS
  A total of 143 outpatients with new onset HF were assessed in a one-stop clinic. A cardiologist evaluation, electrocardiogram, chest X-ray, BNP, and echocardiography (diastolic and systolic study) were performed.
  
  
  RESULTS
  Almost two-thirds (65.7%) were diagnosed with HF: 67% with HF-PEF and 33% HF-REF. Women (71.4% versus 38.7%, P=.002), presence of swelling ankles (61.9% versus 35.5%, P=.016) and higher body mass index (29.8±5.1 versus 27.2±5.0 P=.021) were more frequent in the first group of patients. Echocardiographic signs of diastolic dysfunction and pulmonary hypertension were found in both groups, with higher values of BNP (153.3±123.1 versus 400.8±579.8 P=.025) and troponin I (0.024±0.019 versus 0.071±0.12, P=.037) in HF-REF patients. Female gender and swelling ankles were predictors of HF-PEF in the multivariate analysis, while Q waves and higher values of BNP and heart rate were predictors of HF-REF. A cut-off value of 60.12 pg/ml for BNP provided 83% sensitivity, 84% specificity (AUC=0.898; 95% CI; 0.848-0.948; P <.001).
  
  
  CONCLUSIONS
  The one-stop HF clinic has diagnosed and characterized outpatients with new onset HF and high prevalence of HF-PEF. The cut-off value of 60.12 pg/ml for BNP provides high sensitivity and specificity to identify HF in this population.
authors.affiliation: Servicio de Cardiología, Instituto del Tórax, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IBIDAPS), Universidad de Barcelona, Barcelona, España. randrea@clinic.ub.es
authors.forename: Rut
authors.initials: R
authors.lastname: Andrea
authors.forename: Carlos
authors.initials: C
authors.lastname: Falces
authors.forename: Laura
authors.initials: L
authors.lastname: Sanchis
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
authors.forename: Magda
authors.initials: M
authors.lastname: Heras
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
mesh_terms: D000368:Aged; D000465:Algorithms; D000554:Ambulatory Care Facilities; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D013318:Stroke Volume