Abstract:
AIMS:The aims of this study were to determine the diagnostic yield of a dedicated heart failure diagnosis clinic and the impact of using different guideline recommended N-terminal pro B-type natriuretic peptide (NT-proBNP) referral thresholds on diagnosis and referral patterns. METHODS AND RESULTS:Patients referred by primary care between September 2011 and May 2013 were included in the analysis. Data collected included baseline characteristics, NT-proBNP levels, echocardiographic and clinical findings, final diagnosis and outcome. The impact of using Newcastle (locally modified age-adjusted NT-proBNP thresholds), National Institute for Health and Care Excellence (NICE) and European Society of Cardiology (ESC) NT-proBNP thresholds on diagnosis and referrals was determined by applying the different guidelines to this population. A total of 208 patients were referred; median age 77.5 years and 62.5% were women. Thirty-four patients (16.3%) had systolic heart failure, 50 patients (24.0%) had heart failure with preserved ejection fraction. One hundred and six patients (51.0%) did not have heart failure. Using NICE guidelines (NT-proBNP ≥ 400 ng/l) instead of the Newcastle age-adjusted NT-proBNP referral thresholds results in 59 fewer referrals, but eight heart failure diagnoses were missed. Using the ESC cut-off of NT-proBNP ≥ 125 ng/l would result in 88 additional referrals; one diagnosis of heart failure would be missed. Over a mean follow-up of 16.8 ± 6 months there were 21 deaths and 47 hospital admissions. CONCLUSION:The Newcastle age-adjusted thresholds led to more referrals in comparison to NICE guidelines but are more sensitive in diagnosing heart failure. Using ESC recommended thresholds results in a similar diagnostic yield to our age-adjusted thresholds, but has the potential to significantly increase the referrals in patients ≥ 75 years, which may result in a lower diagnostic yield.
journal_name
Int J Clin Practjournal_title
International journal of clinical practiceauthors
Fazal IA,Bhagra SK,Bailey KM,Dermot Neely R,MacGowan GA,Skinner JSdoi
10.1111/ijcp.12694subject
Has Abstractpub_date
2015-11-01 00:00:00pages
1349-56issue
11eissn
1368-5031issn
1742-1241journal_volume
69pub_type
杂志文章abstract::The aim of this review was to outline current forms of surgical simulation and methods of assessing technical skills using these forms of simulation. To review this subject, a literature search was done using key words 'assessment', 'simulation', 'surgery', 'technical skills' and 'virtual reality'. Simulation in surge...
journal_title:International journal of clinical practice
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