在动脉粥样硬化风险社区（ARIC）研究中心力衰竭的分类：诊断标准的比较。

Classification of heart failure in the atherosclerosis risk in communities (ARIC) study: a comparison of diagnostic criteria.

机构信息

Departments of Epidemiology, University of North Carolina at Chapel Hill, 137 E Franklin St, Suite 203, Chapel Hill, NC 27514, USA.

出版信息

Circ Heart Fail. 2012 Mar 1;5(2):152-9. doi: 10.1161/CIRCHEARTFAILURE.111.963199. Epub 2012 Jan 23.

DOI:10.1161/CIRCHEARTFAILURE.111.963199

PMID:22271752

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3326579/

Abstract

BACKGROUND

Population-based research on heart failure (HF) is hindered by lack of consensus on diagnostic criteria. Framingham (FRM), National Health and Nutrition Examination Survey (NHANES), Modified Boston (MBS), Gothenburg (GTH), and International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) code criteria, do not differentiate acute decompensated heart failure (ADHF) from chronic stable HF. We developed a new classification protocol for identifying ADHF in the Atherosclerosis Risk in Communities (ARIC) Study and compared it with these other schemes.

METHODS AND RESULTS

A sample of 1180 hospitalizations with a patient address in 4 study communities and eligible discharge codes were selected. After assessing whether the chart contained evidence of possible HF signs, 705 were fully abstracted. Two independent reviewers classified each case as ADHF, chronic stable HF, or no HF, using ARIC classification guidelines. Fifty-nine percent of cases met ARIC criteria for ADHF and 13.9% and 27.1% were classified as chronic stable HF or no HF, respectively. Among events classified as HF by FRM criteria, 68.4% were validated as ADHF, 9.6% as chronic stable HF, and 21.9% as no HF. However, 92.5% of hospitalizations with a primary ICD-9-CM 428 "heart failure" code were validated as ADHF. Sensitivities of comparison criteria to classify ADHF ranged from 38-95%, positive predictive values from 62-92%, and specificities from 19-96%.

CONCLUSIONS

Although comparison criteria for classifying HF were moderately sensitive in identifying ADHF, specificity varied when applied to a randomly selected set of suspected HF hospitalizations in the community.

摘要

背景

基于人群的心力衰竭（HF）研究受到缺乏诊断标准共识的阻碍。弗雷明汉（FRM）、国家健康和营养检查调查（NHANES）、改良波士顿（MBS）、哥德堡（GTH）和国际疾病分类，第 9 修订版，临床修正（ICD-9-CM）代码标准，无法区分急性失代偿性心力衰竭（ADHF）与慢性稳定型 HF。我们为识别社区动脉粥样硬化风险研究（ARIC）中的 ADHF 开发了一种新的分类方案，并将其与其他方案进行了比较。

方法和结果

选择了在 4 个研究社区具有患者地址的 1180 例住院患者样本，并符合出院代码标准。在评估病历是否包含可能的 HF 体征的证据后，对 705 例进行了全面摘录。两名独立的审查员使用 ARIC 分类指南将每个病例分类为 ADHF、慢性稳定型 HF 或无 HF。59%的病例符合 ARIC 的 ADHF 标准，分别有 13.9%和 27.1%被归类为慢性稳定型 HF 或无 HF。在 FRM 标准分类为 HF 的事件中，68.4%被验证为 ADHF，9.6%为慢性稳定型 HF，21.9%为无 HF。然而，92.5%的主要 ICD-9-CM 428“心力衰竭”代码的住院治疗被验证为 ADHF。比较标准对 ADHF 的分类敏感性范围为 38-95%，阳性预测值为 62-92%，特异性为 19-96%。