http://repub.eur.nl/res/aut/14968/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/26274/ 2011-06-01T00:00:00Z Background: Diagnosing early stages of heart failure with mild symptoms is difficult. B-type natriuretic peptide (BNP) has promising biochemical test characteristics, but its diagnostic yield on top of readily available diagnostic knowledge has not been sufficiently quantified in early stages of heart failure. Objectives: To quantify the added diagnostic value of BNP for the diagnosis of heart failure in a population relevant to GPs and validate the findings in an independent primary care patient population. Design: Individual patient data meta-analysis followed by external validation. The additional diagnostic yield of BNP above standard clinical information was compared with ECG and chest x-ray results. Patients and methods: Derivation was performed on two existing datasets from Hillingdon (n=127) and Rotterdam (n=149) while the UK Natriuretic Peptide Study (n=306) served as validation dataset. Included were patients with suspected heart failure referred to a rapid-access diagnostic outpatient clinic. Case definition was according to the ESC guideline. Logistic regression was used to assess discrimination (with the c-statistic) and calibration. Results: Of the 276 patients in the derivation set, 30.8% had heart failure. The clinical model (encompassing age, gender, known coronary artery disease, diabetes, orthopnoea, elevated jugular venous pressure, crackles, pitting oedema and S3 gallop) had a c-statistic of 0.79. Adding, respectively, chest x-ray results, ECG results or BNP to the clinical model increased the c-statistic to 0.84, 0.85 and 0.92. Neither ECG nor chest x-ray added significantly to the 'clinical plus BNP' model. All models had adequate calibration. The 'clinical plus BNP' diagnostic model performed well in an independent cohort with comparable inclusion criteria (c-statistic=0.91 and adequate calibration). Using separate cut-off values for 'ruling in' (typically implying referral for echocardiography) and for 'ruling out' heart failure - creating a grey zone - resulted in insufficient proportions of patients with a correct diagnosis. Conclusion: BNP has considerable diagnostic value in addition to signs and symptoms in patients suspected of heart failure in primary care. However, using BNP alone with the currently recommended cut-off levels is not sufficient to make a reliable diagnosis of heart failure. http://repub.eur.nl/res/pub/12933/ 2001-08-22T00:00:00Z AIMS: To determine the prognosis, cause of death, and its determinants in participants of the population-based Rotterdam Study who were found to have heart failure. METHODS AND RESULTS: In 5255 Rotterdam Study participants (aged 68.9+/-8.6 years, 3113 women) the presence of heart failure was determined. Data were analysed with Cox's proportional-hazards models. One hundred and eighty-one participants (age 77.3+/-7.9 years, 109 women) had heart failure. Of these 85 (47%) died during the 4.8-8.5 (mean 6.1) years of follow-up. One, 2 and 5 years' survival was 89%, 79%, and 59%, representing an age-adjusted mortality twice that of persons without heart failure (hazard ratio 2.1, 95% CI 1.8-2.7). The hazard ratio for sudden death was even more pronounced: 4.8, (95% CI 2.6-8.7). Diabetes mellitus, impairment of renal function and atrial fibrillation were associated with a poor outcome. A higher blood pressure and body mass index conferred a more favourable prognosis in those with heart failure. CONCLUSION: Heart failure generally afflicts older subjects in the community, carries a poor prognosis, especially in the presence of concomitant diseases, and confers a fivefold increase in the risk of sudden death. http://repub.eur.nl/res/pub/21280/ 2000-02-16T00:00:00Z Heart failure is a clinical syndrome with various causes for which no universally accepted definition exists. Packer's definition of heart failure "representing a complex clinical syndrome characterised by abnonnalities of left ventricular function and neurohumoral regulation. which are accompanied by effort intolerance, fluid retention and reduced longevity" reveals the complexity of the syndrome. Heart failure is one of the commonest cardiovascular disorders in Western Society and a growing major public health problem. It has been estimated that in the Netherlands the number of hospital discharges for heart failure rose from 14441 in 1980 to 25966 in 1993. The prevalence of heart failure rises rapidly with age from 0.7% in those aged 55-64 to 13.0% in those aged 74-84.4 This indicates a rapidly expanding problem mainly due to an increase in the number of elderly. Despite the facl that heart failure and its precursor left ventricular systolic dysfunction are increasingly being recognised as important causes for morbidity and mortality, epidemiologic data are scarce. l For example, reliable information on the incidence of the syndrome is very limited. One of the reasons of the lack of epidemiologic data on heart failure is the difficulty of diagnosing early slages of heart failure and the virtual absence of target cohort studies. In the Netherlands and in the UK most heart failure patients are detected and treated in general practice. Heart failure is difficult to diagnose by the general practitioner due to the unavailability of morc sophisticated or invasive diagnostic tools and is primarily based on clinical judgement. In recent years neurohumoral and Doppler echocardiographic measurements have emerged as noninvasive tools that could aid in the diagnosis of heart failure, also in a non-hospital setting. Heart fallure carries a poor prognosis, but, again, data from population-based studies, notably those addressing the prognostic implications of asymptomatic ventricular dysfullction, is limited.