Proactive screening for symptoms: A simple method to improve early detection of unrecognized cardiovascular disease in primary care. Results from the Lifelines Cohort Study.
Atrial fibrillation
Cardiovascular diseases
Cohort studies
Coronary artery disease
Diagnostic screening programs
Early diagnosis
Heart failure
Primary health care
Signs and symptoms
Journal
Preventive medicine
ISSN: 1096-0260
Titre abrégé: Prev Med
Pays: United States
ID NLM: 0322116
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
28
01
2020
revised:
20
04
2020
accepted:
24
05
2020
pubmed:
31
5
2020
medline:
25
6
2021
entrez:
31
5
2020
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 32473262
pii: S0091-7435(20)30167-5
doi: 10.1016/j.ypmed.2020.106143
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
106143Informations de copyright
Copyright © 2020 The Author(s). Published by Elsevier Inc. All rights reserved.