Clinical diagnosis of heart failure in nursing home residents based on history, physical exam, BNP and ECG: Is it reliable?

IntroductionHeart failure (HF) is highly prevalent in nursing home residents. To diagnose HF properly, echocardiography is recommended by cardiology guidelines. In nursing homes, the nursing home physician (NHP) usually diagnoses HF based on history, clinical examination, electrocardiography (ECG) and levels of B-type natriuretic peptide only, which is in contrast to the cardiologist who probably always will apply for an echocardiogram. Therefore, we aimed (1) to investigate the agreement on the diagnosis of HF made by the NHP without echocardiography and (2) to determine the clinical characteristics that may contribute to the proper diagnosis of HF in nursing home residents.Materials and methodsThe study followed a cross-sectional design. Nursing home residents in the southern part of the Netherlands, aged over 65 years and receiving long-term somatic or psychogeriatric care, were included in the study. The NHP decided (stepwise) on the diagnosis of HF; first after anamnesis and physical examination, second after additional information on NTproBNP and ECG, and finally, on all available information, except echocardiography. An expert team consisting of two cardiologists and one hospital geriatrician decided on the final diagnosis, based on all available information.Results and conclusionThere was an overall agreement on both correctly identifying residents with HF and correctly excluding HF of 80.4% (kappa 0.57). Characteristics with a high contribution in predicting HF were a history of HF, a high NT-proBNP level, the presence of rales, arrhythmias and use of cardiac medication. NHPs are fairly capable of diagnosing HF in nursing home residents without echocardiography.