Early diagnosis of nonacute heart failure can speed the initiation of treatment leading to improved outcomes, but diagnosis can be difficult on the basis of clinical features alone. A recent study derived and validated a new prediction rule combining clinical features and N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing to aid diagnosis in primary care.
Data from 721 patients (mean age 71 years) with suspected heart failure who were referred to a rapid access outpatient clinic were used to develop a diagnostic score using 10 significant risk factors. In the derivation cohort, 28.7% of patients were diagnosed with heart failure by an expert consensus panel (that was blinded to biomarker data) using clinical and 6-month follow-up data. The diagnostic score was calculated for all patients. Higher scores (> 63 points) were associated with > 80% chance of heart failure, and lower scores (< 24 points) were associated with < 20% chance of heart failure. The rule showed similar performance in 2 retrospective validation cohorts with a total of 407 patients (level 2 [mid-level] evidence), although some of the factors were estimated for analysis in this retrospective validation. (Circulation 2011 Nov 21 early online).
For more information, see the Heart failure and Brain Natriuretic peptide (BNP) testing topics in DynaMed. A calculator for this diagnostic rule will be added to the DynaMed library of online calculators.