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European Journal of Heart Failure 2004 6(6):813-820; doi:10.1016/j.ejheart.2004.08.003
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© 2004 European Society of Cardiology

Evaluation of the performance and concordance of clinical questionnaires for the diagnosis of heart failure in primary care

Cândida Fonsecaa,*,1, António G. Oliveirab,2, Teresa Motac,3,4, Fernando Matiasd,5, Humberto Moraisd,5, Catarina Costad,5, Fátima Ceiae,1,6 and on behalf of the EPICA Investigators7

a Department of Internal Medicine, Medical Sciences School, New University of Lisbon, Lisbon, Portugal
b Datamedica Ltd., Lisbon, Portugal
c Department of Cardiology, Medical Sciences School, New University of Lisbon, Lisbon, Portugal
d EPICA Working Group, Lisbon, Portugal
e Department of Medical Therapeutics, Medical Sciences School, New University of Lisbon, Lisbon, Portugal

* Corresponding author. Current address. R. Salvador Barata Feyo no. 1 r/c D.to 2780-355 Oeiras, Portugal. Tel.: +351 21 443 81 61; fax: +351 21 301 7958.. E-mail address: candidafonseca{at}netc.pt


  Abstract

Aim: To validate and estimate the performance statistics and concordance of seven clinical questionnaires for the diagnosis of chronic heart failure (HF).

Methods: Community-based epidemiological survey of patients aged >25 years attending a random sample of primary health care centers in Portugal. Heart failure was identified according to the Guidelines of the European Society of Cardiology (ESC).

Results: A total of 5434 subjects evaluated by 365 investigators were eligible for analysis, 551 of which had criteria for heart failure. Overall, the questionnaires had high specificity, usually above 90%, but low sensitivity, providing an increase in the likelihood of heart failure from 4.3% pre-test to 25–35% post-test in most cases. The Göteborg questionnaire was the most balanced regarding sensitivity (84%) and specificity (81%) but this may reflect its use of prescription of digoxin or diuretics as diagnostic criteria for diagnosis. The Walma, Framingham and NHANES-I questionnaires performed similarly (Sensitivity: 63%, Specificity: 93%), while the Boston and the Gheorghiade questionnaires had a somewhat lower sensitivity (55%). Concordance was good between the Boston, Framingham, Gheorghiade, NHANES-I and Walma questionnaires.

Conclusions: This study evaluated seven clinical questionnaires for the diagnosis of heart failure in the community. Their low sensitivity impairs their usefulness as diagnostic instruments, but their high specificity makes them useful for the identification of patients with fluid retention and/or exercise intolerance from non-cardiac causes.

Key Words: Heart failure • Epidemiology • Diagnosis • Echocardiography • Left ventricular dysfunction

Received July 6, 2004; Accepted August 25, 2004

1 Serviço de Medicina, Hospital S. Francisco Xavier, 1400 Lisboa, Portugal.

2 Datamedica, R. Garcia de Orta 70, 2 D, 1200 Lisboa, Portugal.

3 Serviço de Cardiologia, Hospital Pulido Valente, 1750 Lisboa, Portugal.

4 R. do Loreto no. 34-3°, 1200 Lisboa, Portugal.

5 Grupo de Investigaço EPICA, Av. António Augusto de Aguiar 128, 1050 Lisboa, Portugal.

6 Av. Grão Vasco 47-1°-Esq, 1500-336 Lisboa, Portugal.

7 EPICA Investigators and Steering Committee Members are listed in the appendix (doi:10.1016/j.ejheart.2004.09.002).


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