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Evaluation of the performance and concordance of clinical questionnaires for the diagnosis of heart failure in primary care
Author(s) -
Fonseca Cândida,
Oliveira António G.,
Mota Teresa,
Matias Fernando,
Morais Humberto,
Costa Catarina,
Ceia Fátima
Publication year - 2004
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 - 10.1016/j.ejheart.2004.08.003
Subject(s) - medicine , concordance , heart failure , digoxin , medical prescription , epidemiology , framingham heart study , primary care , test (biology) , physical therapy , framingham risk score , emergency medicine , cardiology , family medicine , disease , paleontology , pharmacology , biology
Aim: To validate and estimate the performance statistics and concordance of seven clinical questionnaires for the diagnosis of chronic heart failure (HF). Methods: Community‐based epidemiological survey of patients aged >25 years attending a random sample of primary health care centers in Portugal. Heart failure was identified according to the Guidelines of the European Society of Cardiology (ESC). Results: A total of 5434 subjects evaluated by 365 investigators were eligible for analysis, 551 of which had criteria for heart failure. Overall, the questionnaires had high specificity, usually above 90%, but low sensitivity, providing an increase in the likelihood of heart failure from 4.3% pre‐test to 25–35% post‐test in most cases. The Göteborg questionnaire was the most balanced regarding sensitivity (84%) and specificity (81%) but this may reflect its use of prescription of digoxin or diuretics as diagnostic criteria for diagnosis. The Walma, Framingham and NHANES‐I questionnaires performed similarly (Sensitivity: 63%, Specificity: 93%), while the Boston and the Gheorghiade questionnaires had a somewhat lower sensitivity (55%). Concordance was good between the Boston, Framingham, Gheorghiade, NHANES‐I and Walma questionnaires. Conclusions This study evaluated seven clinical questionnaires for the diagnosis of heart failure in the community. Their low sensitivity impairs their usefulness as diagnostic instruments, but their high specificity makes them useful for the identification of patients with fluid retention and/or exercise intolerance from non‐cardiac causes.