natriuretic-peptide--brain and Respiratory-Sounds

Diagnosis of heart failure in primary care is often inaccurate, and access to and use of echocardiography is suboptimal. This study aimed to develop and provisionally validate a clinical prediction rule to optimize referral for echocardiography of people identified in primary care with suspected heart failure.. A systematic review identified studies of diagnosis of heart failure set in primary care. The individual patient data for five of these studies were obtained. Logistic regression models to predict heart failure were developed on one of the data sets and validated on the others using area under the receiver operating characteristic curve (AUROC), and goodness-of-fit calibration plots. A model based upon four simple clinical features (Male, history of myocardial Infarction, Crepitations, Edema: MICE) and natriuretic peptide had good validity when applied to other data sets, with AUROCs between 0.84 and 0.93, and reasonable calibration. The rule performed well across the data sets, with sensitivity between 81% and 96% and specificity between 57% and 74%.. A simple clinical rule based upon gender, history of myocardial infarction, presence of ankle oedema, and presence of basal lung crepitations can discriminate between people with suspected heart failure who should be referred straight for echocardiography and people for whom referral should depend upon the result of a natriuretic peptide test. Prospective validation and an implementation evaluation of the rule is now warranted.

Topics: Aged; Aged, 80 and over; Decision Support Techniques; Echocardiography; Edema; Female; Heart Failure; Humans; Logistic Models; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Primary Health Care; Prospective Studies; Referral and Consultation; Respiratory Sounds; ROC Curve; Sensitivity and Specificity; Sex Factors

We conducted a cross-sectional study to investigate which factors have a significant impact on wheezing and QOL in the elderly of a Japanese local community.. In 2008, 527 participants (250 participants aged 45 to 64 years and 277 participants aged 65 to 88 years) responded to the questionnaire regarding wheezing and disease history. QOL was evaluated by the Short Form-8. The participants underwent airway reversibility testing. The plasma levels of IgE were measured. The plasma levels of N-terminal-pro-B-type natriuretic peptide were measured in twenty-one participants with a history of ischemic heart disease and in thirty-five age-matched participants without that history.. Wheezing was reported by 50 (9.5%) participants and was associated with a lower score of QOL. In multivariate analysis, wheezing was associated with sex (OR 3.12, CI 1.10-9.67) and a history of bronchial asthma (OR 22.3, CI 6.50-84.0) among participants aged 45 to 64 years. Among participants aged 65 and over, wheezing was associated with a history of bronchial asthma (OR 4.86, CI 1.39-15.1) and ischemic heart disease (OR 5.12, CI 1.61-15.0). Participants with both a history of ischemic heart disease and wheezing showed higher levels of N-terminal-pro-B-type natriuretic peptide. Airway reversibility was only associated with a history of ischemic heart disease (OR 4.65, CI 1.26-17.6).. It is suggested that bronchial asthma and heart disease are both significant causes of wheezing and affect the QOL in the elderly of a Japanese local community.

Topics: Aged; Aged, 80 and over; Asian People; Asthma; Cross-Sectional Studies; Female; Humans; Immunoglobulin E; Japan; Male; Middle Aged; Myocardial Ischemia; Natriuretic Peptide, Brain; Peptide Fragments; Quality of Life; Respiratory Sounds; Surveys and Questionnaires

We undertook this analysis to determine whether there is a relationship between the time to measurement of immunoreactive B-type natriuretic peptide (iBNP) and early intervention for acutely decompensated heart failure (ADHF) and whether these variables are associated with morbidity and mortality in ADHF patients.. Although natriuretic peptides (NPs) can aid emergency department (ED) physicians in the diagnosis of ADHF, the relationship between the time to measurement of NP levels and time to treatment is not clear. In addition, the impact of time to treatment on clinical outcomes has not been demonstrated.. Patients from ADHERE (Acute Decompensated Heart Failure National Registry) who were admitted to the ED and who received intravenous diuretics were included. Recordings of iBNP levels and the timing of intravenous diuretic therapy were documented. Patients were divided by quartiles of time to treatment and iBNP levels, creating 16 categories.. In 58,465 ADHF episodes from 209 hospitals, patients with the longest average time to iBNP draw also had the longest time to treatment. Mean ED time increased with increased time-to-treatment quartiles. Rales on initial examination were associated with early recognition of HF and earlier institution of therapy. The later the treatment took place, the fewer patients were asymptomatic at the time of hospital discharge. Within the time-to-treatment quartiles, mortality increased with increasing iBNP. Treatment delay was independently, but modestly, associated with increased in-hospital mortality with a risk-adjusted odds ratio 1.021, 95% confidence interval 1.010 to 1.033, and p < 0.0001, per every 4-h delay.. In the ED setting, delayed measurement of iBNP levels and delay in treatment for ADHF were strongly associated. These delays were linked with modestly increased in-hospital mortality, independent of other prognostic variables. The adverse impact of delay was most notable in patients with greater iBNP levels (Registry for Acute Decompensated Heart Failure Patients; NCT00366639).

Topics: Acute Disease; Aged; Aged, 80 and over; Biomarkers; Diuretics; Emergency Service, Hospital; Female; Heart Failure; Hospital Mortality; Humans; Infusions, Intravenous; Male; Middle Aged; Natriuretic Peptide, Brain; Odds Ratio; Patient Admission; Prognosis; Registries; Respiratory Sounds; Risk Assessment; Time Factors; United States