Real-world clinical diagnostics of heart failure patients with reduced or preserved ejection fraction
Real-world clinical diagnostics of heart failure patients with reduced or preserved ejection fraction
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DOI：
10.1002/ehf2.12665
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发表时间：
2020-03-18
影响因子：
3.8
通讯作者：
Ukkonen, Heikki
中科院分区：
文献类型：
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作者：
Huusko, Jenni;Purmonen, Timo;Ukkonen, Heikki
本研究旨在调查指南推荐的诊断工具和药物在芬兰西南部专科护理心力衰竭（HF）患者中的使用情况。我们还比较了诊断和未诊断患者的特征以及日常临床实践中的实验室检查、程序和治疗。方法和结果诊断为HF、心肌病或高血压诱发的心脏病的患者（n = 20 878，主要队列）或未诊断为HF但有N末端脑钠肽前体升高记录在2005-2017年期间，来自芬兰西南医院区专科护理患者登记册的NT-proBNP（>125 ng/L，n = 24 321，次要队列）被纳入研究。在具有国际疾病分类第十修订版（ICD-10）HF代码的患者中，只有50%的患者具有通过电子健康记录的数据挖掘发现的射血分数（EF）数据。在这些患者中，39%（n = 4042）的EF> 40%。升高的NT-proBNP与EF > 40%一起将数量缩小至4590例患者，该人群定义为EF保留的HF（HFpEF）患者。HFpEF患者进一步分层为EF轻度降低的HF（HFmrEF; EF 41- 50%，n = 1468）和EF > 50%的患者（n = 3122），以比较临床特征。HFrEF患者的NT-proBNP高于HFpEF患者{4580 [四分位距（IQR）：2065-9765] vs. 2900 [2065-9765] ng/L，P < 0.001}。HFpEF和HFrEF组之间的基线合并症不同。此外，HFpEF患者在诊断前进行的手术和实验室检查比HFrEF患者多。发现HFmrEF患者比EF > 50%的患者更类似于HFrEF。在次要队列中70%（n = 17 156）的患者中，NT-proBNP浓度>300 ng/L，中位数为1090（IQR 551-2558）ng/L，EF为58.4 +/- 12.1%（可用EF的n = 6845）。减少EF是目前在6.8%的患者缺乏HF diagnosis.Conclusions ICD-10代码HF的患者中有一半没有EF数据后，在专科护理访问。特别是，HFpEF的诊断似乎具有挑战性，反映为与HFrEF患者相比，诊断前的程序和实验室检查增加。此外，大部分患者未诊断为HF，但他们的NT-proBNP浓度升高，临床特征与HFpEF患者相似。
Aims The study aimed at investigating the use of guideline-recommended diagnostic tools and medication in patients with heart failure (HF) in specialty care in Southwest Finland. We also compared the characteristics of the diagnosed and undiagnosed patients as well as laboratory tests, procedures, and treatments in everyday clinical practice.Methods and results Patients diagnosed with HF, cardiomyopathy, or hypertension-induced heart disease (n = 20 878, primary cohort) or not diagnosed with HF but having a record of elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) (>125 ng/L, n = 24 321, secondary cohort) were included in the study from the specialty care patient register of the Hospital District of Southwest Finland during the years 2005-2017. Among patients with an International Classification of Diseases, Tenth Revision (ICD-10) code for HF, only 50% had ejection fraction (EF) data to be found by data mining from the electronic health records. Of these patients, 39% (n = 4042) had EF 40%. Elevated NT-proBNP together with EF > 40% narrowed down the number to 4590 patients, a population defined as HF with preserved EF (HFpEF) patients. HFpEF patients were further stratified into HF with mildly reduced EF (HFmrEF; EF 41-50%, n = 1468) and EF > 50% patients (n = 3122) to compare clinical characteristics. NT-proBNP was higher within the HFrEF patients vs. HFpEF {4580 [inter-quartile range (IQR): 2065-9765] vs. 2900 [2065-9765] ng/L, P < 0.001}. Baseline co-morbidities differed between HFpEF and HFrEF groups. Further, HFpEF patients had more procedures and lab tests taken prior to diagnosis than had HFrEF patients. HFmrEF patients were found to resemble more HFrEF than EF > 50% patients. In 70% (n = 17 156) of patients in the secondary cohort, the NT-proBNP concentrations were >300 ng/L, median was 1090 (IQR 551-2558) ng/L and EF 58.4 +/- 12.1% (n with EF available = 6845). Reduced EF was present in 6.8% of patients lacking HF diagnosis.Conclusions Half of the patients with ICD-10 code for HF did not have EF data available after a visit at specialty care. In particular, the diagnosis of HFpEF seems challenging, reflected as an increase in procedures and laboratory test preceding diagnosis compared with those in HFrEF patients. Also, a large proportion of patients did not have HF diagnosis, yet they presented elevated NT-proBNP concentrations and clinical characteristics resembling those of HFpEF patients.