Diagnóstico de la insuficiencia cardíaca con fracción de eyección preservada o reducida mediante una consulta de alta resolución

OBJECTIVES: a) To assess the usefulness of a one-stop clinic for the diagnosis of outpatients with new onset heart failure; b) to characterize these patients comparing preserved (HF-PEF) versus reduced ejection fraction (HF-REF), and c) to determine brain natriuretic peptide (BNP) cut-off limit to identify HF in outpatients. DESIGN: Observational descriptive study. SETTING: Primary care. PARTICIPANTS AND MEASUREMENTS: A total of 143 outpatients with new onset HF were assessed in a one-stop clinic. A cardiologist evaluation, electrocardiogram, chest X-ray, BNP, and echocardiography (diastolic and systolic study) were performed. RESULTS: Almost two-thirds (65.7%) were diagnosed with HF: 67% with HF-PEF and 33% HF-REF. Women (71.4% versus 38.7%, P = .002), presence of swelling ankles (61.9% versus 35.5%, P = .016) and higher body mass index (29.8 ± 5.1 versus 27.2 ± 5.0 P = .021) were more frequent in the first group of patients. Echocardiographic signs of diastolic dysfunction and pulmonary hypertension were found in both groups, with higher values of BNP (153.3 ± 123.1 versus 400.8 ± 579.8 P = .025) and troponin I (0.024 ± 0.019 versus 0.071 ± 0.12, P = .037) in HF-REF patients. Female gender and swelling ankles were predictors of HF-PEF in the multivariate analysis, while Q waves and higher values of BNP and heart rate were predictors of HF-REF. A cut-off value of 60.12 pg/ml for BNP provided 83% sensitivity, 84% specificity (AUC = 0.898; 95% CI; 0.848-0.948; P <.001). CONCLUSIONS: The one-stop HF clinic has diagnosed and characterized outpatients with new onset HF and high prevalence of HF-PEF. The cut-off value of 60.12 pg/ml for BNP provides high sensitivity and specificity to identify HF in this population.