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Efficiently screening heart failure in patients with type 2 diabetes
Author(s) -
Boonmande Winter Leandra J.M.,
Rutten Frans H.,
Cramer Maarten J.,
Landman Marcel J.,
Zuithoff Nicolaas P.A.,
Liem Anho H.,
Hoes Arno W.
Publication year - 2015
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.216
Subject(s) - medicine , heart failure , confidence interval , cardiology , medical history , physical examination , diabetes mellitus , medical diagnosis , intensive care medicine , pathology , endocrinology
Aims Our aim was to develop a screening tool for heart failure in patients with type 2 diabetes. Methods and results A total of 581 consecutive patients from 21 primary care practices in The Netherlands with type 2 diabetes, in whom the diagnosis of heart failure ( HF ) was not known, underwent an extensive diagnostic assessment, including medical history taking, physical examination, ECG , and echocardiography. The presence or absence of HF was established by a panel of two cardiologists and one general practitioner following the guidelines on HF of the European Society of Cardiology. In 161 patients, HF was considered present. A model based on the medical history and symptoms had a good discriminative value for detecting or excluding HF [C‐statistic after bootstrapping 0.80; 95% confidence interval ( CI ) 0.76–0.83]. Adding signs improved the C‐statistic to 0.82 (95% CI 0.79–0.86). A diagnostic screening score based on the clinical model had good discriminative properties applying a cut‐off of 3 points (24.7% risk of HF ) with sensitivity 70.8%, specificity 79.0%, negative predictive value 87.6%, and positive predictive value 56.4%. ECG and natriuretic peptides both had independent added value beyond the clinical model and increased the C‐statistic to 0.86 (95% CI 0.83– 0.89). With a 20% threshold, the net reclassification of adding ECG and NT‐proBNP to the clinical model was only 0.06. Conclusions A decision aid based on items from the clinical assessment is useful for screening HF in older patients with type 2 diabetes and to pre‐select for echocardiography. Trial registration NL2271704108.