Utility of biomarkers in the differential diagnosis of heart failure in older people: findings from the heart failure in care homes (HFinCH) diagnostic accuracy study.
<h4>Background</h4>The performance of biomarkers for heart failure (HF) in older residents in long-term care is poorly understood and has not differentiated between left ventricular systolic dysfunction (LVSD) and HF with preserved ejection fraction (HFpEF).<h4>Methods</h4>Th...
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2013-01-01
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| author | James M Mason Helen C Hancock Helen Close Jerry J Murphy Ahmet Fuat Mark de Belder Raj Singh Andrew Teggert Esther Wood Gill Brennan Nehal Hussain Nitin Kumar Novin Manshani David Hodges Douglas Wilson A Pali S Hungin |
| author_facet | James M Mason Helen C Hancock Helen Close Jerry J Murphy Ahmet Fuat Mark de Belder Raj Singh Andrew Teggert Esther Wood Gill Brennan Nehal Hussain Nitin Kumar Novin Manshani David Hodges Douglas Wilson A Pali S Hungin |
| author_sort | James M Mason |
| collection | DOAJ |
| description | <h4>Background</h4>The performance of biomarkers for heart failure (HF) in older residents in long-term care is poorly understood and has not differentiated between left ventricular systolic dysfunction (LVSD) and HF with preserved ejection fraction (HFpEF).<h4>Methods</h4>This is the first diagnostic accuracy study in this population to assess the differential diagnostic performance and acceptability of a range of biomarkers against a clinical diagnosis using portable echocardiography. A total of 405 residents, aged 65-100 years (mean 84.2), in 33 UK long-term care facilities were enrolled between April 2009 and June 2010.<h4>Results</h4>For undifferentiated HF, BNP or NT-proBNP were adequate rule-out tests but would miss one in three cases (BNP: sensitivity 67%, NPV 86%, cut-off 115 pg/ml; NT-proBNP: sensitivity 62%, NPV 87%, cut-off 760 pg/ml). Using higher test cut-offs, both biomarkers were more adequate tests of LVSD, but would still miss one in four cases (BNP: sensitivity 76%, NPV 97%, cut-off 145 pg/ml; NT-proBNP: sensitivity 73%, NPV 97%, cut-off 1000 pg/ml). At these thresholds one third of subjects would test positive and require an echocardiogram. Applying a stricter 'rule out' threshold (sensitivity 90%), only one in 10 cases would be missed, but two thirds of subjects would require further investigation. Biomarkers were less useful for HFpEF (BNP: sensitivity 63%, specificity 61%, cut-off 110 pg/ml; NT-proBNP: sensitivity 68%, specificity 56%, cut-off 477 pg/ml). Novel biomarkers (Copeptin, MR-proADM, and MR-proANP) and common signs and symptoms had little diagnostic utility.<h4>Conclusions</h4>No test, individually or in combination, adequately balanced case finding and rule-out for heart failure in this population; currently, in-situ echocardiography provides the only adequate diagnostic assessment.<h4>Trial registration</h4>Controlled-Trials.com ISRCTN19781227. |
| format | Article |
| id | doaj-art-21d87375720e443ebe5afeac4c7edc08 |
| institution | OA Journals |
| issn | 1932-6203 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj-art-21d87375720e443ebe5afeac4c7edc082025-08-20T02:30:58ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-0181e5356010.1371/journal.pone.0053560Utility of biomarkers in the differential diagnosis of heart failure in older people: findings from the heart failure in care homes (HFinCH) diagnostic accuracy study.James M MasonHelen C HancockHelen CloseJerry J MurphyAhmet FuatMark de BelderRaj SinghAndrew TeggertEsther WoodGill BrennanNehal HussainNitin KumarNovin ManshaniDavid HodgesDouglas WilsonA Pali S Hungin<h4>Background</h4>The performance of biomarkers for heart failure (HF) in older residents in long-term care is poorly understood and has not differentiated between left ventricular systolic dysfunction (LVSD) and HF with preserved ejection fraction (HFpEF).<h4>Methods</h4>This is the first diagnostic accuracy study in this population to assess the differential diagnostic performance and acceptability of a range of biomarkers against a clinical diagnosis using portable echocardiography. A total of 405 residents, aged 65-100 years (mean 84.2), in 33 UK long-term care facilities were enrolled between April 2009 and June 2010.<h4>Results</h4>For undifferentiated HF, BNP or NT-proBNP were adequate rule-out tests but would miss one in three cases (BNP: sensitivity 67%, NPV 86%, cut-off 115 pg/ml; NT-proBNP: sensitivity 62%, NPV 87%, cut-off 760 pg/ml). Using higher test cut-offs, both biomarkers were more adequate tests of LVSD, but would still miss one in four cases (BNP: sensitivity 76%, NPV 97%, cut-off 145 pg/ml; NT-proBNP: sensitivity 73%, NPV 97%, cut-off 1000 pg/ml). At these thresholds one third of subjects would test positive and require an echocardiogram. Applying a stricter 'rule out' threshold (sensitivity 90%), only one in 10 cases would be missed, but two thirds of subjects would require further investigation. Biomarkers were less useful for HFpEF (BNP: sensitivity 63%, specificity 61%, cut-off 110 pg/ml; NT-proBNP: sensitivity 68%, specificity 56%, cut-off 477 pg/ml). Novel biomarkers (Copeptin, MR-proADM, and MR-proANP) and common signs and symptoms had little diagnostic utility.<h4>Conclusions</h4>No test, individually or in combination, adequately balanced case finding and rule-out for heart failure in this population; currently, in-situ echocardiography provides the only adequate diagnostic assessment.<h4>Trial registration</h4>Controlled-Trials.com ISRCTN19781227.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0053560&type=printable |
| spellingShingle | James M Mason Helen C Hancock Helen Close Jerry J Murphy Ahmet Fuat Mark de Belder Raj Singh Andrew Teggert Esther Wood Gill Brennan Nehal Hussain Nitin Kumar Novin Manshani David Hodges Douglas Wilson A Pali S Hungin Utility of biomarkers in the differential diagnosis of heart failure in older people: findings from the heart failure in care homes (HFinCH) diagnostic accuracy study. PLoS ONE |
| title | Utility of biomarkers in the differential diagnosis of heart failure in older people: findings from the heart failure in care homes (HFinCH) diagnostic accuracy study. |
| title_full | Utility of biomarkers in the differential diagnosis of heart failure in older people: findings from the heart failure in care homes (HFinCH) diagnostic accuracy study. |
| title_fullStr | Utility of biomarkers in the differential diagnosis of heart failure in older people: findings from the heart failure in care homes (HFinCH) diagnostic accuracy study. |
| title_full_unstemmed | Utility of biomarkers in the differential diagnosis of heart failure in older people: findings from the heart failure in care homes (HFinCH) diagnostic accuracy study. |
| title_short | Utility of biomarkers in the differential diagnosis of heart failure in older people: findings from the heart failure in care homes (HFinCH) diagnostic accuracy study. |
| title_sort | utility of biomarkers in the differential diagnosis of heart failure in older people findings from the heart failure in care homes hfinch diagnostic accuracy study |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0053560&type=printable |
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