Development and validation of a decision support tool for the diagnosis of acute heart failure: systematic review, meta- analysis, and modelling study
Por:
Lee, KK, Doudesis, D, Anwar, M, Astengo, F, Chenevier-Gobeaux, C, Claessens, YE, Wussler, D, Kozhuharov, N, Strebel, I, Sabti, Z, deFilippi, C, Seliger, S, Moe, G, Fernando, C, Bayes-Genis, A, van Kimmenade, RRJ, Pinto, Y, Gaggin, HK, Wiemer, JC, Mockel, M, Rutten, JHW, van den Meiracker, AH, Gargani, L, Pugliese, NR, Pemberton, C, Ibrahim, I, Gegenhuber, A, Mueller, T, Neumaier, M, Behnes, M, Akin, I, Bombelli, M, Grassi, G, Nazerian, P, Albano, G, Bahrmann, P, Newby, DE, Japp, AG, Tsanas, A, Shah, ASV, Richards, AM, McMurray, JJV, Mueller, C, Januzzi, JL and Mills, NL
Publicada:
14 jun 2022
Resumen:
OBJECTIVES To evaluate the diagnostic performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds for acute heart failure and to develop and validate a decision support tool that combines NT-proBNP concentrations with clinical characteristics. DESIGN Individual patient level data meta-analysis and modelling study. SETTING Fourteen studies from 13 countries, including randomised controlled trials and prospective observational studies. PARTICIPANTS Individual patient level data for 10 369 patients with suspected acute heart failure were pooled for the meta-analysis to evaluate NT-proBNP thresholds. A decision support tool (Collaboration for the Diagnosis and Evaluation of Heart Failure (CoDE-HF)) that combines NT-proBNP with clinical variables to report the probability of acute heart failure for an individual patient was developed and validated. MAIN OUTCOME MEASURE Adjudicated diagnosis of acute heart failure. RESULTS Overall, 43.9% (4549/10 369) of patients had an adjudicated diagnosis of acute heart failure (73.3% (2286/3119) and 29.0% (1802/6208) in those with and without previous heart failure, respectively). The negative predictive value of the guideline recommended rule-out threshold of 300 pg/mL was 94.6% (95% confidence interval 91.9% to 96.4%); despite use of age specific rule-in thresholds, the positive predictive value varied at 61.0% (55.3% to 66.4%), 73.5% (62.3% to 82.3%), and 80.2% (70.9% to 87.1%), in patients aged <50 years, 50-75 years, and >75 years, respectively. Performance varied in most subgroups, particularly patients with obesity, renal impairment, or previous heart failure. CoDE-HF was well calibrated, with excellent discrimination in patients with and without previous heart failure (area under the receiver operator curve 0.846 (0.830 to 0.862) and 0.925 (0.919 to 0.932) and Brier scores of 0.130 and 0.099, respectively). In patients without previous heart failure, the diagnostic performance was consistent across all subgroups, with 40.3% (2502/6208) identified at low probability (negative predictive value of 98.6%, 97.8% to 99.1%) and 28.0% (1737/6208) at high probability (positive predictive value of 75.0%, 65.7% to 82.5%) of having acute heart failure. CONCLUSIONS In an international, collaborative evaluation of the diagnostic performance of NT-proBNP, guideline recommended thresholds to diagnose acute heart failure varied substantially in important patient subgroups. The CoDE-HF decision support tool incorporating NT-proBNP as a continuous measure and other clinical variables provides a more consistent, accurate, and individualised approach. STUDY REGISTRATION PROSPERO CRD42019159407.
Filiaciones:
Lee, KK:
Univ Edinburgh, British Heart Fdn Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland
Doudesis, D:
Univ Edinburgh, British Heart Fdn Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland
Univ Edinburgh, Usher Inst, Edinburgh, Midlothian, Scotland
Anwar, M:
Univ Edinburgh, British Heart Fdn Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland
Astengo, F:
Univ Edinburgh, British Heart Fdn Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland
Chenevier-Gobeaux, C:
Cochin Hosp, Assistance Publ Hop Paris, Dept Biochem, Paris, France
Claessens, YE:
Princess Grace Hosp Ctr, Dept Emergency Med, Monaco, Monaco
Wussler, D:
Univ Hosp Basel, Cardiovasc Res Inst Basel, Dept Cardiol, Basel, Switzerland
Univ Basel, Univ Hosp Basel, Dept Internal Med, Basel, Switzerland
Kozhuharov, N:
Univ Hosp Basel, Cardiovasc Res Inst Basel, Dept Cardiol, Basel, Switzerland
Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England
Strebel, I:
Univ Hosp Basel, Cardiovasc Res Inst Basel, Dept Cardiol, Basel, Switzerland
Sabti, Z:
Univ Hosp Basel, Cardiovasc Res Inst Basel, Dept Cardiol, Basel, Switzerland
deFilippi, C:
Inova Heart & Vasc Inst, Falls Church, VA USA
Seliger, S:
Univ Maryland, Sch Med, Div Nephrol, Baltimore, MD 21201 USA
Moe, G:
Univ Toronto, St Michaels Hosp, Toronto, ON, Canada
Fernando, C:
Univ Toronto, St Michaels Hosp, Toronto, ON, Canada
:
Hosp Univ Germans Trias Pujol, Heart Inst, CIBERCV, Badalona, Spain
van Kimmenade, RRJ:
Radboud Univ Nijmegen, Dept Cardiol, Med Ctr, Nijmegen, Netherlands
Pinto, Y:
Univ Amsterdam, Amsterdam, Netherlands
Gaggin, HK:
Harvard Med Sch, Boston, MA 02115 USA
Massachusetts Gen Hosp, Div Cardiol, Boston, MA USA
Wiemer, JC:
BRAHMS, Thermo Fisher Sci, Hennigsdorf, Germany
Mockel, M:
Charite Univ Med Berlin, Dept Emergency & Acute Med, Chest Pain Units, Campus Mitte & Virchow, Berlin, Germany
Rutten, JHW:
Radboud Univ Nijmegen, Dept Internal Med, Med Ctr, Nijmegen, Netherlands
van den Meiracker, AH:
Erasmus MC, Dept Internal Med, Div Pharmacol & Vasc Med, Rotterdam, Netherlands
Gargani, L:
Univ Pisa, Dept Surg Med & Mol Pathol & Crit Care Med, Pisa, Italy
Pugliese, NR:
Univ Pisa, Dept Clin & Expt Med, Pisa, Italy
Pemberton, C:
Univ Otago, Christchurch Heart Inst, Christchurch, New Zealand
Ibrahim, I:
Natl Univ Singapore Hosp, Emergency Med Dept, Singapore, Singapore
Gegenhuber, A:
Krankenhaus Bad Ischl, Dept Internal Med, Bad Ischl, Austria
Mueller, T:
Hosp Voecklabruck, Dept Lab Med, Voecklabruck, Austria
Neumaier, M:
Heidelberg Univ, Univ Med Ctr Mannheim, Inst Clin Chem, Fac Med Mannheim, Mannheim, Germany
Behnes, M:
Heidelberg Univ, Univ Med Ctr Mannheim, Fac Med Mannheim, Dept Med 1, Mannheim, Germany
Akin, I:
Heidelberg Univ, Univ Med Ctr Mannheim, Fac Med Mannheim, Dept Med 1, Mannheim, Germany
Bombelli, M:
Univ Milano Bicocca, ASST Brianza, Pio Hosp Desio 11, Internal Med, Desio, Italy
Grassi, G:
Univ Milano Bicocca, Clin Med, Milan, Italy
Nazerian, P:
Univ Careggi, Azienda Osped, Dept Emergency Med, Florence, Italy
Albano, G:
Univ Careggi, Azienda Osped, Dept Emergency Med, Florence, Italy
Bahrmann, P:
Heidelberg Univ, Univ Hosp Heidelberg, Dept Internal Med 3, Div Cardiol, Heidelberg, Germany
Newby, DE:
Univ Edinburgh, British Heart Fdn Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland
Japp, AG:
Univ Edinburgh, British Heart Fdn Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland
Tsanas, A:
Univ Edinburgh, Usher Inst, Edinburgh, Midlothian, Scotland
Shah, ASV:
Univ Edinburgh, British Heart Fdn Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland
London Sch Hyg & Tropical Med, London, England
Richards, AM:
Univ Otago, Christchurch Heart Inst, Christchurch, New Zealand
Natl Univ Heart Ctr Singapore, Cardiovasc Res Inst, Singapore, Singapore
McMurray, JJV:
Univ Glasgow, British Heart Fdn Cardiovasc Res Ctr, Glasgow, Lanark, Scotland
Mueller, C:
Univ Hosp Basel, Cardiovasc Res Inst Basel, Dept Cardiol, Basel, Switzerland
Januzzi, JL:
Harvard Med Sch, Boston, MA 02115 USA
Massachusetts Gen Hosp, Div Cardiol, Boston, MA USA
Mills, NL:
Univ Edinburgh, British Heart Fdn Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland
Univ Edinburgh, Usher Inst, Edinburgh, Midlothian, Scotland
Green Published, Green Accepted, hybrid
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