Miek Smeets1, Jan Degryse2, Bert Aertgeerts3, Stefan Janssens4, Wim Adriaensen2, Catharina Matheï3, Gijs Van Pottelbergh5, Pierre Wallemacq6, Jean-Louis Vanoverschelde7, Bert Vaes2. 1. Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium. Electronic address: Miek.Smeets@med.kuleuven.be. 2. Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium; Institute of Health and Society, Université Catholique de Louvain (UCL), Brussels, Belgium. 3. Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium. 4. Department of Cardiovascular Diseases, Universitair Ziekenhuis Gasthuisberg, KU Leuven (KUL), Leuven, Belgium. 5. Department of Public Health and Primary Care, KU Leuven (KUL), Leuven, Belgium; Department of Health and Technology, Leuven University College, Leuven, Belgium. 6. Laboratory of Analytical Biochemistry, Cliniques Universitaires St Luc, Université Catholique de Louvain (UCL), Brussels, Belgium. 7. Department of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain (UCL), Brussels, Belgium.
Abstract
BACKGROUND AND OBJECTIVES: Conflicting evidence exists about the value of general practitioners' (GPs') diagnoses of chronic heart failure (CHF), especially in older persons. Therefore, the relationship between GPs' judgement of CHF and objective cardiac abnormalities and their respective prognostic value for 5-year mortality in patients aged 80 and older was studied. METHODS AND RESULTS: These analyses were embedded within the prospective, population-based BELFRAIL study. At baseline, 525 patients (mean age 85 ± 3.7 years, 37% men) were clinically assessed by their GPs, had NT-proBNP levels determined and received a detailed echocardiography at home. GPs were asked to judge the presence of CHF and to list their arguments in favour or against CHF. Cause-specific mortality was collected until 5.2 ± 0.25 years after baseline. GPs suspected CHF in 154 patients (29%). The prevalence of objective cardiac abnormalities was 35% (n=183). GPs' judgement predicted objective cardiac abnormalities inaccurately (sensitivity 45% (95% CI 38-53), specificity 79% (95% CI 75-83)). However, both objective cardiac abnormalities and GPs' diagnoses of CHF were good predictors of 5-year mortality (HR 2.1 (95% CI 1.6-2.7) vs 1.7 (95% CI 1.3-2.3), respectively). Furthermore, the presence of objective cardiac abnormalities was not significantly better than GPs' judgement in identifying patients at risk for mortality, although a trend for better cardiovascular mortality risk classification was noted (NRI 10% (95% CI -2 to 21%), P=0.13). CONCLUSIONS: Although GPs' judgement of CHF and objective cardiac abnormalities correlated poorly, the validity of GPs' clinical judgement for mortality risk stratification was demonstrated.
BACKGROUND AND OBJECTIVES: Conflicting evidence exists about the value of general practitioners' (GPs') diagnoses of chronic heart failure (CHF), especially in older persons. Therefore, the relationship between GPs' judgement of CHF and objective cardiac abnormalities and their respective prognostic value for 5-year mortality in patients aged 80 and older was studied. METHODS AND RESULTS: These analyses were embedded within the prospective, population-based BELFRAIL study. At baseline, 525 patients (mean age 85 ± 3.7 years, 37% men) were clinically assessed by their GPs, had NT-proBNP levels determined and received a detailed echocardiography at home. GPs were asked to judge the presence of CHF and to list their arguments in favour or against CHF. Cause-specific mortality was collected until 5.2 ± 0.25 years after baseline. GPs suspected CHF in 154 patients (29%). The prevalence of objective cardiac abnormalities was 35% (n=183). GPs' judgement predicted objective cardiac abnormalities inaccurately (sensitivity 45% (95% CI 38-53), specificity 79% (95% CI 75-83)). However, both objective cardiac abnormalities and GPs' diagnoses of CHF were good predictors of 5-year mortality (HR 2.1 (95% CI 1.6-2.7) vs 1.7 (95% CI 1.3-2.3), respectively). Furthermore, the presence of objective cardiac abnormalities was not significantly better than GPs' judgement in identifying patients at risk for mortality, although a trend for better cardiovascular mortality risk classification was noted (NRI 10% (95% CI -2 to 21%), P=0.13). CONCLUSIONS: Although GPs' judgement of CHF and objective cardiac abnormalities correlated poorly, the validity of GPs' clinical judgement for mortality risk stratification was demonstrated.
Authors: Miek Smeets; Jan Degryse; Stefan Janssens; Catharina Matheï; Pierre Wallemacq; Jean-Louis Vanoverschelde; Bert Aertgeerts; Bert Vaes Journal: BMJ Open Date: 2016-10-06 Impact factor: 2.692