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dc.contributor.authorLee, Kuan Ken
dc.contributor.authorDoudesis, Dimitrios
dc.contributor.authorAnwar, Mohamed
dc.contributor.authorAstengo, Federica
dc.contributor.authorChenevier-Gobeaux, Camille
dc.contributor.authorClaessens, Yann-Erick
dc.contributor.authorWussler, Desiree
dc.contributor.authorKozhuharov, Nikola
dc.contributor.authorStrebel, Ivo
dc.contributor.authorSabti, Zaid
dc.contributor.authordeFilippi, Christopher
dc.contributor.authorSeliger, Stephen
dc.contributor.authorMoe, Gordon
dc.contributor.authorFernando, Carlos
dc.contributor.authorBayes-Genis, Antoni
dc.contributor.authorvan Kimmenade, Roland R J
dc.contributor.authorPinto, Yigal
dc.contributor.authorGaggin, Hanna K
dc.contributor.authorWiemer, Jan C
dc.contributor.authorMöckel, Martin
dc.contributor.authorRutten, Joost H W
dc.contributor.authorvan den Meiracker, Anton H
dc.contributor.authorGargani, Luna
dc.contributor.authorPugliese, Nicola R
dc.contributor.authorPemberton, Christopher
dc.contributor.authorIbrahim, Irwani
dc.contributor.authorGegenhuber, Alfons
dc.contributor.authorMueller, Thomas
dc.contributor.authorNeumaier, Michael
dc.contributor.authorBehnes, Michael
dc.contributor.authorAkin, Ibrahim
dc.contributor.authorBombelli, Michele
dc.contributor.authorGrassi, Guido
dc.contributor.authorNazerian, Peiman
dc.contributor.authorAlbano, Giovanni
dc.contributor.authorBahrmann, Philipp
dc.contributor.authorNewby, David E
dc.contributor.authorJapp, Alan G
dc.contributor.authorTsanas, Athanasios
dc.contributor.authorShah, Anoop S V
dc.contributor.authorRichards, A Mark
dc.contributor.authorMcMurray, John J V
dc.contributor.authorMueller, Christian
dc.contributor.authorJanuzzi, James L
dc.contributor.authorMills, Nicholas L
dc.date.accessioned2022-06-16T13:42:24Z
dc.date.available2022-06-16T13:42:24Z
dc.date.issued2022-06-13
dc.identifier.urihttp://hdl.handle.net/10713/19188
dc.description.abstractObjectives: To evaluate the diagnostic performance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) thresholds for acute heart failure and to develop and validate a decision support tool that combines NT-proBNP concentrations with clinical characteristics. Design: Individual patient level data meta-analysis and modelling study. Setting: Fourteen studies from 13 countries, including randomised controlled trials and prospective observational studies. Participants: Individual patient level data for 10 369 patients with suspected acute heart failure were pooled for the meta-analysis to evaluate NT-proBNP thresholds. A decision support tool (Collaboration for the Diagnosis and Evaluation of Heart Failure (CoDE-HF)) that combines NT-proBNP with clinical variables to report the probability of acute heart failure for an individual patient was developed and validated. Main outcome measure: Adjudicated diagnosis of acute heart failure. Results: Overall, 43.9% (4549/10 369) of patients had an adjudicated diagnosis of acute heart failure (73.3% (2286/3119) and 29.0% (1802/6208) in those with and without previous heart failure, respectively). The negative predictive value of the guideline recommended rule-out threshold of 300 pg/mL was 94.6% (95% confidence interval 91.9% to 96.4%); despite use of age specific rule-in thresholds, the positive predictive value varied at 61.0% (55.3% to 66.4%), 73.5% (62.3% to 82.3%), and 80.2% (70.9% to 87.1%), in patients aged <50 years, 50-75 years, and >75 years, respectively. Performance varied in most subgroups, particularly patients with obesity, renal impairment, or previous heart failure. CoDE-HF was well calibrated, with excellent discrimination in patients with and without previous heart failure (area under the receiver operator curve 0.846 (0.830 to 0.862) and 0.925 (0.919 to 0.932) and Brier scores of 0.130 and 0.099, respectively). In patients without previous heart failure, the diagnostic performance was consistent across all subgroups, with 40.3% (2502/6208) identified at low probability (negative predictive value of 98.6%, 97.8% to 99.1%) and 28.0% (1737/6208) at high probability (positive predictive value of 75.0%, 65.7% to 82.5%) of having acute heart failure. Conclusions: In an international, collaborative evaluation of the diagnostic performance of NT-proBNP, guideline recommended thresholds to diagnose acute heart failure varied substantially in important patient subgroups. The CoDE-HF decision support tool incorporating NT-proBNP as a continuous measure and other clinical variables provides a more consistent, accurate, and individualised approach. Study registration: PROSPERO CRD42019159407.en_US
dc.description.urihttps://doi.org/10.1136/bmj-2021-068424en_US
dc.language.isoenen_US
dc.publisherBMJ Publishing Groupen_US
dc.relation.ispartofBMJ (Clinical Research Ed.)en_US
dc.rights© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ.en_US
dc.titleDevelopment and validation of a decision support tool for the diagnosis of acute heart failure: systematic review, meta-analysis, and modelling study.en_US
dc.typeArticleen_US
dc.identifier.doi10.1136/bmj-2021-068424
dc.identifier.pmid35697365
dc.source.journaltitleBMJ (Clinical research ed.)
dc.source.volume377
dc.source.beginpagee068424
dc.source.endpage
dc.source.countryEngland


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