[Diagnostic accuracy for heart failure – data from the Akershus Cardiac Examination 2 Study].
BACKGROUND
Diagnosing heart failure in an on-call setting can be difficult, and international studies report diagnostic accuracy among duty doctors, as measured using area under the ROC curve (AUC), to be 0.76-0.90. This study has examined the accuracy with which doctors in the internal medicine out-of-hours service in a Norwegian university hospital distinguish heart failure from no heart failure in patients with dyspnoea.


METHODS
Information was gathered on 468 patients admitted to Akershus University Hospital with dyspnoea between June 2009 and November 2010, and 314 patients were included in the study. The duty doctors estimated the probability of heart failure (0-100%) before N-terminal pro-B-type natriuretic peptide (NTproBNP) concentrations were known. The final diagnosis for the hospital admission was made retrospectively by two independent doctors after review of the medical records, including supplementary tests and the patient outcome.


RESULTS
Heart failure was considered the cause of hospitalisation in 143 patients (46%). Patients with heart failure were older, more often men, had a higher prevalence of heart disease, reduced/impaired renal function, and higher NTproBNP concentrations than patients with non-heart failure dyspnoea. The diagnostic accuracy among duty doctors for heart failure (AUC) was 0.86 (95% confidence interval 0.82-0.90). The doctors' diagnostic accuracy was lower when the patient had heart failure with left ventricular ejection fraction [LVEF] ≥ 50% (n=52): AUC 0.83 (0.77-0.87).


CONCLUSIONS
The duty doctors at Akershus University Hospital from 2009-2010 demonstrated similar diagnostic accuracy for heart failure as previously reported from international centres. Diagnostic accuracy was lower for heart failure patients with LVEF ≥ 50%.
Medisinsk divisjon Akershus universitetssykehus og Senter for hjertesviktforskning og K.G. Jebsen-senter for hjerteforskning Institutt for klinisk medisin Universitetet i Oslo.
Jon
J
Brynildsen
Medisinsk divisjon Akershus universitetssykehus og Senter for hjertesviktforskning og K.G. Jebsen-senter for hjerteforskning Institutt for klinisk medisin Universitetet i Oslo.
Arne Didrik
AD
Høiseth
Institutt for eksperimentell medisinsk forskning Oslo universitetssykehus, Ullevål og Senter for hjertesviktforskning og K.G. Jebsen-senter for hjerteforskning Institutt for klinisk medisin Universitetet i Oslo.
Ståle
S
Nygård
Tverrfaglig laboratoriemedisin og medisinsk biokjemi Divisjon for diagnostikk og teknologi Akershus universitetssykehus og Institutt for klinisk medisin Universitetet i Oslo.
Tor-Arne
TA
Hagve
Institutt for eksperimentell medisinsk forskning Oslo universitetssykehus, Ullevål og Senter for hjertesviktforskning og K.G. Jebsen-senter for hjerteforskning Institutt for klinisk medisin Universitetet i Oslo.
Geir
G
Christensen
Medisinsk divisjon Akershus universitetssykehus og Senter for hjertesviktforskning og K.G. Jebsen-senter for hjerteforskning Institutt for klinisk medisin Universitetet i Oslo.
Torbjørn
T
Omland
Medisinsk divisjon Akershus universitetssykehus og Senter for hjertesviktforskning og K.G. Jebsen-senter for hjerteforskning Institutt for klinisk medisin Universitetet i Oslo.
Helge
H
Røsjø
D039602:After-Hours Care; D000368:Aged; D000369:Aged, 80 and over; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis*; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D009664:Norway; D010446:Peptide Fragments / Q000097:blood; D010820:Physicians; D012372:ROC Curve; D011795:Surveys and Questionnaires
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain