title: General practitioners' judgement of chronic heart failure in the oldest old: Insights from the BELFRAIL study.
abstract: OBJECTIVE
  Conflicting evidence exists about the value of general practitioners' (GPs') diagnoses of chronic heart failure (CHF), especially in older persons. Therefore, the relationship between GPs' judgement of CHF and objective cardiac abnormalities and their respective prognostic value for 5-year mortality in patients aged 80 and older was studied.
  
  
  RESULTS
  These analyses were embedded within the prospective, population-based BELFRAIL study. At baseline, 525 patients (mean age 85 ± 3.7 years, 37% men) were clinically assessed by their GPs, had NT-proBNP levels determined and received a detailed echocardiography at home. GPs were asked to judge the presence of CHF and to list their arguments in favour or against CHF. Cause-specific mortality was collected until 5.2 ± 0.25 years after baseline. GPs suspected CHF in 154 patients (29%). The prevalence of objective cardiac abnormalities was 35% (n=183). GPs' judgement predicted objective cardiac abnormalities inaccurately (sensitivity 45% (95% CI 38-53), specificity 79% (95% CI 75-83)). However, both objective cardiac abnormalities and GPs' diagnoses of CHF were good predictors of 5-year mortality (HR 2.1 (95% CI 1.6-2.7) vs 1.7 (95% CI 1.3-2.3), respectively). Furthermore, the presence of objective cardiac abnormalities was not significantly better than GPs' judgement in identifying patients at risk for mortality, although a trend for better cardiovascular mortality risk classification was noted (NRI 10% (95% CI -2 to 21%), P=0.13).
  
  
  CONCLUSIONS
  Although GPs' judgement of CHF and objective cardiac abnormalities correlated poorly, the validity of GPs' clinical judgement for mortality risk stratification was demonstrated.
authors.affiliation: Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium. Electronic address: Miek.Smeets@med.kuleuven.be.
authors.forename: Miek
authors.initials: M
authors.lastname: Smeets
authors.affiliation: Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium; Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Degryse
authors.affiliation: Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium.
authors.forename: Bert
authors.initials: B
authors.lastname: Aertgeerts
authors.affiliation: Department of Cardiovascular Diseases, Universitair Ziekenhuis Gasthuisberg, KU Leuven (KUL), Leuven, Belgium.
authors.forename: Stefan
authors.initials: S
authors.lastname: Janssens
authors.affiliation: Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium; Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Adriaensen
authors.affiliation: Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium.
authors.forename: Catharina
authors.initials: C
authors.lastname: Matheï
authors.affiliation: Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium; Department of Health and Technology, Leuven University College, Leuven, Belgium.
authors.forename: Gijs
authors.initials: G
authors.lastname: Van Pottelbergh
authors.affiliation: Laboratory of Analytical Biochemistry, Cliniques Universitaires St Luc, Université Catholique de Louvain (UCL), Brussels, Belgium.
authors.forename: Pierre
authors.initials: P
authors.lastname: Wallemacq
authors.affiliation: Department of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vanoverschelde
authors.affiliation: Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium; Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium.
authors.forename: Bert
authors.initials: B
authors.lastname: Vaes
mesh_terms: D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D002983:Clinical Competence; D018618:Echocardiography, Doppler, Color; D005260:Female; D058005:General Practitioners; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends
keywords: Aged, 80 and over; Diagnosis; General practice; Heart failure; Mortality