Proactive screening for symptoms: A simple method to improve early detection of unrecognized cardiovascular disease in primary care. Results from the Lifelines Cohort Study

PREVENTIVE MEDICINE

卷:138

Article

Zwartkruis, Victor W.¹  Groenewegen, Amy²  Rutten, Frans H.²  Hollander, Monika²  Hoes, Arno W.²  van der Ende, M. Yldau¹  van der Harst, Pim^1,3  Cramer, Maarten Jan³  van der Schouw, Yvonne T.²  Koffijberg, Hendrik⁴  Rienstra, Michiel¹  de Boer, Rudolf A.¹ 

[1] Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands

[2] Univ Utrecht, Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands

[3] Univ Utrecht, Univ Med Ctr Utrecht, Dept Cardiol, Utrecht, Netherlands

[4] Univ Twente, Dept Hlth Technol & Serv Res, Enschede, Netherlands

关键词: Early diagnosis;    Signs and symptoms;    Cardiovascular diseases;    Atrial fibrillation;    Heart failure;    Coronary artery disease;    Cohort studies;    Diagnostic screening programs;    Primary health care;   

DOI  :  10.1016/j.ypmed.2020.106143

来源: Elsevier

【 摘 要 】

Cardiovascular disease (CVD) often goes unrecognized, despite symptoms frequently being present. Proactive screening for symptoms might improve early recognition and prevent disease progression or acute cardiovascular events. We studied the diagnostic value of symptoms for the detection of unrecognized atrial fibrillation (AF), heart failure (HF), and coronary artery disease (CAD) and developed a corresponding screening questionnaire. We included 100,311 participants (mean age 52 +/- 9 years, 58% women) from the population-based Lifelines Cohort Study. For each outcome (unrecognized AF/HF/CAD), we built a multivariable model containing demographics and symptoms. These models were combined into one 'three-disease' diagnostic model and questionnaire for all three outcomes. Results were validated in Lifelines participants with chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM). Unrecognized CVD was identified in 1325 participants (1.3%): AF in 131 (0.1%), HF in 599 (0.6%), and CAD in 687 (0.7%). Added to age, sex, and body mass index, palpitations were independent predictors for unrecognized AF; palpitations, chest pain, dyspnea, exercise intolerance, health-related stress, and self-expected health worsening for unrecognized HF; smoking, chest pain, exercise intolerance, and claudication for unrecognized CAD. Area under the curve for the combined diagnostic model was 0.752 (95% CI 0.737-0.766) in the total population and 0.757 (95% CI 0.734-0.781) in participants with COPD and DM. At the chosen threshold, the questionnaire had low specificity, but high sensitivity. In conclusion, a short questionnaire about demographics and symptoms can improve early detection of CVD and help pre-select people who should or should not undergo further screening for CVD.

【 授权许可】

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