Evidence map›Paper›PMID 35697365›Full record

SynthesisBMJ (Clinical research ed.)2022

Development and validation of a decision support tool for the diagnosis of acute heart failure: systematic review, meta-analysis, and modelling study.

Kuan Ken Lee, Dimitrios Doudesis, Mohamed Anwar, Federica Astengo, Camille Chenevier-Gobeaux, Yann-Erick Claessens, Desiree Wussler, Nikola Kozhuharov, Ivo Strebel, Zaid Sabti and 36 more

Registry-linked trialAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05518396 (Prospective Validation of the CoDE-HF Algorithm for the Diagnosis of Acute Heart Failure), which is not on this map. Cited by 33 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05518396 active not recruitingnot on this map

Prospective Validation of the CoDE-HF Algorithm for the Diagnosis of Acute Heart Failure

TypeobservationalSponsorUniversity of EdinburghRan2021 to 2028Enrolled3,808ConditionsAcute Heart Failure, DiagnosisArmsCoDE-HF decision support tool
3 · Its place in the literature

Who cites it

33 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. NT-proBNP in the very old population: reference values and heart failure specificity from the AugUR-study.Clinical research in cardiology : official journal of the German Cardiac Society · 2026
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  20. Atrial cardiomyopathy revisited-evolution of a concept: a clinical consensus statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asian Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS).Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

46 authors.

Kuan Ken LeeBritish Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Dimitrios DoudesisBritish Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Mohamed AnwarBritish Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Federica AstengoBritish Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Camille Chenevier-GobeauxDepartment of Biochemistry, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Paris, France.
Yann-Erick ClaessensDepartment of Emergency Medicine, Princess Grace Hospital Center, Monaco, Principality of Monaco.
Desiree WusslerCardiovascular Research Institute of Basel, Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Nikola KozhuharovCardiovascular Research Institute of Basel, Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Ivo StrebelCardiovascular Research Institute of Basel, Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Zaid SabtiCardiovascular Research Institute of Basel, Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Christopher deFilippiInova Heart and Vascular Institute, Falls Church, VA, USA.
Stephen SeligerDivision of Nephrology, University of Maryland School of Medicine, Baltimore, MD, USA.
Gordon MoeUniversity of Toronto, St Michael's Hospital, Toronto, ON, Canada.
Carlos FernandoUniversity of Toronto, St Michael's Hospital, Toronto, ON, Canada.
Antoni Bayes-GenisHeart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, CIBERCV, Spain.
Roland R J van KimmenadeDepartment of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands.
Yigal PintoUniversity of Amsterdam, Amsterdam, Netherlands.
Hanna K GagginHarvard Medical School, Boston, MA, USA.
Jan C WiemerBRAHMS, Thermo Fisher Scientific, Hennigsdorf, Germany.
Martin MöckelDepartment of Emergency and Acute Medicine with Chest Pain Units, Charité - Universitätsmedizin Berlin, Campus Mitte and Virchow, Berlin, Germany.
Joost H W RuttenDepartment of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands.
Anton H van den MeirackerDepartment of Internal Medicine, Division of Pharmacology and Vascular Medicine, Erasmus Medical Center, Rotterdam, Netherlands.
Luna GarganiDepartment of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
Nicola R PuglieseDepartment of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Christopher PembertonChristchurch Heart Institute, University of Otago, Christchurch, New Zealand.
Irwani IbrahimEmergency Medicine Department, National University Hospital, Singapore.
Alfons GegenhuberDepartment of Internal Medicine, Krankenhaus Bad Ischl, Bad Ischl, Austria.
Thomas MuellerDepartment of Laboratory Medicine, Hospital Voecklabruck, Voecklabruck, Austria.
Michael NeumaierInstitute for Clinical Chemistry, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
Michael BehnesFirst Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
Ibrahim AkinFirst Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
Michele BombelliUniversity of Milan Bicocca, ASST-Brianza, Pio XI Hospital of Desio, Internal Medicine, Desio, Italy.
Guido GrassiClinica Medica, University Milan Bicocca, Milan, Italy.
Peiman NazerianDepartment of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Giovanni AlbanoDepartment of Emergency Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
Philipp BahrmannDepartment of Internal Medicine III, Division of Cardiology, University Hospital of Heidelberg, Ruprecht-Karls University Heidelberg, Heidelberg, Germany.
David E NewbyBritish Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Alan G JappBritish Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Athanasios TsanasUsher Institute, University of Edinburgh, Edinburgh, UK.
Anoop S V ShahBritish Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
A Mark RichardsChristchurch Heart Institute, University of Otago, Christchurch, New Zealand.
John J V McMurrayBritish Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Christian MuellerCardiovascular Research Institute of Basel, Department of Cardiology, University Hospital Basel, Basel, Switzerland.
James L JanuzziHarvard Medical School, Boston, MA, USA.
Nicholas L MillsBritish Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK nick.mills@ed.ac.uk.ORCID 0000-0003-0533-7991
CoDE-HF investigators

Funding

British Heart Foundation CH/09/002/26360British Heart Foundation FS/18/25/33454
6 · The paper itself

Abstract

objectivesTo 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.

designIndividual patient level data meta-analysis and modelling study.

settingFourteen studies from 13 countries, including randomised controlled trials and prospective observational studies.

participantsIndividual 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 measureAdjudicated diagnosis of acute heart failure.

resultsOverall, 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.

conclusionsIn 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.

Indexed as

Heart FailureNatriuretic Peptide, BrainBiomarkersDiagnosis, DifferentialHumansObservational Studies as TopicPeptide FragmentsPredictive Value of TestsProspective StudiesBiomarkersNatriuretic Peptide, BrainPeptide Fragments

Identifiers

PMID35697365
PMCPMC9189738

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.