Development and validation of a decision support tool for the diagnosis of acute heart failure: systematic review, meta-analysis, and modelling study
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 da...
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| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
13 June 2022
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| In: |
The BMJ
Year: 2022, Jahrgang: 377, Pages: 1-15 |
| ISSN: | 1756-1833 |
| DOI: | 10.1136/bmj-2021-068424 |
| Online-Zugang: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1136/bmj-2021-068424 Verlag, lizenzpflichtig, Volltext: https://www.bmj.com/content/377/bmj-2021-068424 
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| Verfasserangaben: | Kuan Ken Lee, Dimitrios Doudesis, Mohamed Anwar, Federica Astengo, Camille Chenevier-Gobeaux, Yann-Erick Claessens, Desiree Wussler, Nikola Kozhuharov, Ivo Strebel, Zaid Sabti, Christopher deFilippi, Stephen Seliger, Gordon Moe, Carlos Fernando, Antoni Bayes-Genis, Roland R.J. van Kimmenade, Yigal Pinto, Hanna K. Gaggin, Jan C. Wiemer, Martin Möckel, Joost H.W. Rutten, Anton H. van den Meiracker, Luna Gargani, Nicola R. Pugliese, Christopher Pemberton, Irwani Ibrahim, Alfons Gegenhuber, Thomas Mueller, Michael Neumaier, Michael Behnes, Ibrahim Akin, Michele Bombelli, Guido Grassi, Peiman Nazerian, Giovanni Albano, Philipp Bahrmann, David E. Newby, Alan G. Japp, Athanasios Tsanas, Anoop S.V. Shah, A. Mark Richards, John J.V. McMurray, Christian Mueller, James L. Januzzi, Nicholas L. Mills, on behalf of the CoDE-HF investigators |
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| 245 | 1 | 0 | |a Development and validation of a decision support tool for the diagnosis of acute heart failure |b systematic review, meta-analysis, and modelling study |c Kuan Ken Lee, Dimitrios Doudesis, Mohamed Anwar, Federica Astengo, Camille Chenevier-Gobeaux, Yann-Erick Claessens, Desiree Wussler, Nikola Kozhuharov, Ivo Strebel, Zaid Sabti, Christopher deFilippi, Stephen Seliger, Gordon Moe, Carlos Fernando, Antoni Bayes-Genis, Roland R.J. van Kimmenade, Yigal Pinto, Hanna K. Gaggin, Jan C. Wiemer, Martin Möckel, Joost H.W. Rutten, Anton H. van den Meiracker, Luna Gargani, Nicola R. Pugliese, Christopher Pemberton, Irwani Ibrahim, Alfons Gegenhuber, Thomas Mueller, Michael Neumaier, Michael Behnes, Ibrahim Akin, Michele Bombelli, Guido Grassi, Peiman Nazerian, Giovanni Albano, Philipp Bahrmann, David E. Newby, Alan G. Japp, Athanasios Tsanas, Anoop S.V. Shah, A. Mark Richards, John J.V. McMurray, Christian Mueller, James L. Januzzi, Nicholas L. Mills, on behalf of the CoDE-HF investigators |
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| 520 | |a 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. | ||
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| 700 | 1 | |a Sabti, Zaid |e VerfasserIn |4 aut | |
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