1. Development and validation of a decision support tool for the diagnosis of acute heart failure: systematic review, meta-analysis, and modelling study
- Author
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Lee, K.K., Doudesis, D., Anwar, M., Astengo, F., Chenevier-Gobeaux, C., Claessens, Y.E., Wussler, D., Kozhuharov, N., Strebel, I., Sabti, Z., deFilippi, C., Seliger, S., Moe, G., Fernando, C., Bayes-Genis, A., Kimmenade, R.R.J. van, Pinto, Yigal, Gaggin, H.K., Wiemer, J.C., Möckel, M., Rutten, J.H.W., Meiracker, A.H. van den, Gargani, L., Pugliese, N.R., 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, D.E., Japp, A.G., Tsanas, A., Shah, A.S.V., Richards, A.M.S., McMurray, J.J., Mueller, C., Januzzi, J.L., Jr., Mills, N.L., Lee, K.K., Doudesis, D., Anwar, M., Astengo, F., Chenevier-Gobeaux, C., Claessens, Y.E., Wussler, D., Kozhuharov, N., Strebel, I., Sabti, Z., deFilippi, C., Seliger, S., Moe, G., Fernando, C., Bayes-Genis, A., Kimmenade, R.R.J. van, Pinto, Yigal, Gaggin, H.K., Wiemer, J.C., Möckel, M., Rutten, J.H.W., Meiracker, A.H. van den, Gargani, L., Pugliese, N.R., 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, D.E., Japp, A.G., Tsanas, A., Shah, A.S.V., Richards, A.M.S., McMurray, J.J., Mueller, C., Januzzi, J.L., Jr., and Mills, N.L.
- Abstract
Item does not contain fulltext, 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 al
- Published
- 2022