The REFER REFer for EchocaRdiogram protocol: a prospective validation of a clinical decision rule, NT-proBNP, or their combination, in the diagnosis of heart failure in primary care. Rationale and design.Report as inadecuate




The REFER REFer for EchocaRdiogram protocol: a prospective validation of a clinical decision rule, NT-proBNP, or their combination, in the diagnosis of heart failure in primary care. Rationale and design. - Download this document for free, or read online. Document in PDF available to download.

Reference: Tait, L, Roalfe, AK, Mant, J et al., (2012). The REFER (REFer for EchocaRdiogram) protocol: a prospective validation of a clinical decision rule, NT-proBNP, or their combination, in the diagnosis of heart failure in primary care. Rationale and design. BMC cardiovascular disorders, 12 (1), 97.Citable link to this page:

 

The REFER (REFer for EchocaRdiogram) protocol: a prospective validation of a clinical decision rule, NT-proBNP, or their combination, in the diagnosis of heart failure in primary care. Rationale and design.

Abstract: BACKGROUND: Heart failure is a major cause of mortality and morbidity. As mortality rates are high, it is important that patients seen by general practitioners with symptoms suggestive of heart failure are identified quickly and treated appropriately. Identifying patients with heart failure or deciding which patients need further tests is a challenge. All patients with suspected heart failure should be diagnosed using objective tests such as echocardiography, but it is expensive, often delayed, and limited by the significant skill shortage of trained echocardiographers. Alternative approaches for diagnosing heart failure are currently limited. Clinical decision tools that combine clinical signs, symptoms or patient characteristics are designed to be used to support clinical decision-making and validated according to strict methodological procedures. The REFER Study aims to determine the accuracy and cost-effectiveness of our previously derived novel, simple clinical decision rule, a natriuretic peptide assay, or their combination, in the triage for referral for echocardiography of symptomatic adult patients who present in general practice with symptoms suggestive of heart failure. METHODS/DESIGN: This is a prospective, Phase II observational, diagnostic validation study of a clinical decision rule, natriuretic peptides or their combination, for diagnosing heart failure in primary care. Consecutive adult primary care patients 55 years of age or over presenting to their general practitioner with a chief complaint of recent new onset shortness of breath, lethargy or peripheral ankle oedema of over 48 hours duration, with no obvious recurrent, acute or self-limiting cause will be enrolled. Our reference standard is based upon a three step expert specialist consensus using echocardiography and clinical variables and tests. DISCUSSION: Our clinical decision rule offers a potential solution to the diagnostic challenge of providing a timely and accurate diagnosis of heart failure in primary care. Study results will provide an evidence-base from which to develop heart failure care pathway recommendations and may be useful in standardising care. If demonstrated to be effective, the clinical decision rule will be of interest to researchers, policy makers and general practitioners worldwide. TRIAL REGISTRATION: ISRCTN17635379.

Peer Review status:Peer reviewedPublication status:PublishedVersion:Publisher's version Funder: Medical Research Council   Funder: National Institute for Health Research School for Primary Care Research   Funder: Clinical Research Network   Notes:© 2012 Tait et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Bibliographic Details

Publisher: BioMed Central Ltd.

Publisher Website: http://www.biomedcentral.com/

Journal: BMC cardiovascular disorderssee more from them

Publication Website: http://www.biomedcentral.com/bmccardiovascdisord/

Issue Date: 2012

pages:97Identifiers

Urn: uuid:f822ac65-0f86-49a0-b747-190e57628aaa

Source identifier: 368250

Eissn: 1471-2261

Doi: https://doi.org/10.1186/1471-2261-12-97

Issn: 1471-2261 Item Description

Type: Journal article;

Language: eng

Version: Publisher's versionKeywords: Heart failure Clinical decision rule Diagnosis Echocardiogram NT-proBNP Aged Clinical Protocols Echocardiography Electrocardiography Heart Failure Humans Middle Aged Natriuretic Peptide, Brain Peptide Fragments Primary Health Care Prospective Studies Research DesignSubjects: Cardiovascular disease Tiny URL: pubs:368250

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Author: Tait, L - - - Roalfe, AK - - - Mant, J - - - Cowie, MR - - - Deeks, JJ - - - Iles, R - - - Barton, PM - - - Taylor, CJ - - - Deri

Source: https://ora.ox.ac.uk/objects/uuid:f822ac65-0f86-49a0-b747-190e57628aaa



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