Clinical evaluation of geriatric outpatients with suspected heart failure: value of symptoms, signs, and additional tests
Clinical evaluation of geriatric outpatients with suspected heart failure: value of symptoms, signs, and additional tests
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DOI：
10.1093/eurjhf/hfr021
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发表时间：
2011-05-01
影响因子：
18.2
通讯作者：
Hoes, Arno W.
中科院分区：
文献类型：
--
作者：
Oudejans, Irene;Mosterd, Arend;Hoes, Arno W.
目的心力衰竭(HF)在老年患者中很常见。临床医生面临的诊断挑战主要是由于合并症和有限的获得超声心动图。本研究的目的是确定老年门诊患者存在心力衰竭的独立决定因素，并确定最佳的诊断策略。方法和结果疑似心力衰竭的老年门诊患者[平均年龄82(+/-6)岁，30%的男性]接受了广泛的标准化诊断检查。一个专家协商一致小组确定了HF的存在。206名参与者中有94名(46%)出现了心力衰竭。男性[优势比(OR)2.0]、每10岁年龄(OR 1.6)、夜间呼吸困难(OR 1.7)、无喘息(OR 2.1)、食欲不振(OR 1.7)和体重指数(BMI；OR 0.9)与心衰独立相关：包含这些项目的模型的c统计量为0.75。在所有附加试验中，N-末端前体-B型利钠肽(NT-proBNP)对诊断准确率的提高最大(OR1NT-proBNP为2.8；c统计量为0.92)。由6个临床变量和NT-proBNP组成的诊断规则具有良好的阴性和阳性预测值。结论一半疑似心衰的老年患者确实存在心衰。除了年龄、性别和夜间呼吸困难外，无喘息、食欲不振和较低的BMI与心力衰竭的存在独立相关。症状和体征结合NT-proBNP可可靠地确定绝大多数患者是否存在心力衰竭。额外的诊断测试，特别是超声心动图，可以针对那些仍然不确定是否存在心力衰竭的人，并确定心力衰竭的原因。
Aims 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.Methods and 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.Conclusion 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.