The diagnosis of heart failure in the community - Comparative validation of four sets of criteria in unselected older adults: The ICARe Dicomano study
The diagnosis of heart failure in the community - Comparative validation of four sets of criteria in unselected older adults: The ICARe Dicomano study
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DOI：
10.1016/j.jacc.2004.07.022
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发表时间：
2004-10-19
影响因子：
24
通讯作者：
Marchionni, N
中科院分区：
文献类型：
--
作者：
Di Bari, M;Pozzi, C;Marchionni, N
目的：我们试图在流行病学环境中比较四组心力衰竭（HF）诊断标准的结构效度和预测效度。
背景：心力衰竭的患病率估计因诊断标准不同而有很大差异。
方法：数据来自对意大利迪科马诺居住的年龄≥65岁社区居民的一项调查。在基线时，采用弗雷明汉、波士顿、哥德堡研究以及欧洲心脏病学会（ESC）的标准诊断心力衰竭。比较心力衰竭患者和非心力衰竭参与者的左心室质量指数和射血分数、左心房收缩期内径、下肢活动障碍、综合体能评分以及6分钟步行试验，以检验每组标准的结构效度。通过对心血管死亡率、新发残疾和心力衰竭相关住院情况的随访评估来评价预测效度。对人口统计学特征、合并症和心理情感状态进行了校正比较。
结果：在553名参与者中，根据弗雷明汉、波士顿、哥德堡和ESC标准，分别有11.9%、10.7%、20.8%和9.0%患有心力衰竭。在结构效度方面，在心脏功能和整体表现的各项指标上，弗雷明汉和波士顿标准比哥德堡和ESC标准能更好地区分心力衰竭患者和非心力衰竭参与者。波士顿标准显示出更优的预测效度，因为它表明心力衰竭参与者心血管死亡的校正风险显著更高（风险比3.9，95%置信区间1.2 - 13.2），以及新发残疾和住院风险更高。
结论：对于老年社区居民心力衰竭的诊断，波士顿标准优于弗雷明汉、哥德堡和ESC标准，因为它具有良好的结构效度，并且能更准确地预测心血管死亡、新发残疾和住院情况。（C）2004年美国心脏病学会基金会
OBJECTIVES We sought to compare construct and predictive validity of four sets of heart failure (HF) diagnostic criteria in an epidemiologic setting.BACKGROUND The prevalence estimates of HF vary broadly depending on the diagnostic criteria.METHODS Data were collected in a survey of community dwellers who were E greater than or equal to65 years of age living in Dicomano, Italy. At baseline, HF was diagnosed with the criteria of the Framingham, Boston, and Gothenburg studies and of the European Society of Cardiology (ESC). Left ventricular mass index and ejection fraction, left atrium systolic dimension, lower extremity mobility disability, summary physical performance score, and 6-min walk test were compared between HF and non-HF participants to test for construct validity of each set of criteria. Predictive validity was evaluated with follow-up assessment of cardiovascular mortality, incident disability, and HF-related hospitalizations. Comparisons were adjusted for demographics, comorbidity, and psychoaffective status.RESULTS Of 553 participants, 11.9%,10.7%,20.8%, and 9.0% had HF, according to Framingham, Boston, Gothenburg, and ESC criteria, respectively. In terms of construct validity, Framingham and Boston criteria discriminated HF from non-HF participants better than Gothenburg and ESC criteria across the measures of cardiac function and global performance. The Boston criteria showed a superior predictive validity because they indicated a significantly greater adjusted risk of cardiovascular death (hazard ratio 3.9, 95% confidence interval 1.2 to 13.2), incident disability, and hospitalizations in participants with HF.CONCLUSIONS The Boston criteria are preferable to Framingham, Gothenburg, and ESC criteria for the diagnosis of HF in older community dwellers because they have good construct validity and more accurately predict cardiovascular death, incident disability, and hospitalizations. (C) 2004 by the American College of Cardiology Foundation.