Diagnostisk treffsikkerhet for hjertesvikt - data fra Akershus hjerteundersökelse 2
Sammanfattning
BACKGROUND Diagnosing heart failure in an on-call setting can be difficult, and international studies report diagnostic accuracy among duty
doctors, as measured using area under the ROC curve (AUC), to be 0.76-0.90. This study has examined the accuracy with which doctors in the internal
medicine out-of-hours service in a Norwegian university hospital distinguish heart failure from no heart failure in patients with dyspnoea.
MATERIAL AND METHOD Information was gathered on 468 patients admitted to Akershus University Hospital with dyspnoea between June 2009 and
November 2010, and 314 patients were included in the study. The duty doctors estimated the probability of heart failure (0-100%) before N-terminal
pro-B-type natriuretic peptide (NTproBNP) concentrations were known. The final diagnosis for the hospital admission was made retrospectively by two
independent doctors after review of the medical records, including supplementary tests and the patient outcome.
RESULTS Heart failure was considered the cause of hospitalisation in 143 patients (46%). Patients with heart failure were older, more often men, had a
higher prevalence of heart disease, reduced/impaired renal function, and higher NTproBNP concentrations than patients with non-heart failure
dyspnoea. The diagnostic accuracy among duty doctors for heart failure (AUC) was 0.86 (95% confidence interval 0.82-0.90). The doctors’ diagnostic
accuracy was lower when the patient had heart failure with left ventricular ejection fraction [LVEF] = 50% (n=52): AUC 0.83 (0.77-0.87).
INTERPRETATION The duty doctors at Akershus University Hospital from 2009-2010 demonstrated similar diagnostic accuracy for heart failure as
previously reported from international centres. Diagnostic accuracy was lower for heart failure patients with LVEF = 50%.