Homar Vesna, Mirosevic Spela, Svab Igor, Lainscak Mitja
Department of Family Medicine, Faculty of Medicine, University of Ljubljana, 56 Poljanski nasip, 1000, Ljubljana, Slovenia.
Community Health Centre Vrhnika, Vrhnika, Slovenia.
Heart Fail Rev. 2021 Sep;26(5):1131-1140. doi: 10.1007/s10741-020-09944-w.
The high burden of heart failure in nursing-home populations is due to advanced age and comorbidities. Heart failure is often undiagnosed or misdiagnosed in this population and therefore remains untreated. We review the use of natriuretic peptide biomarkers for screening heart failure in nursing-home residents. The study was performed in accordance with recommendations from the Cochrane Collaboration using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) and is registered in PROSPERO Register of Systematic Reviews. Databases PubMed, Embase, and Trip were searched from 2000 to March 2019, supplemented by hand-searching of references. Studies investigating the nursing-home population were included. The prevalence of heart failure among nursing-home residents was higher than in the general population of comparable age (23% vs 10%, respectively). The rate of misdiagnosis in nursing homes ranged from 25 to 76%. NT-proBNP was the most commonly used natriuretic peptide biomarker for heart failure screening. The mean value of NT-proBNP was significantly higher in residents with heart failure than in residents overall (pooled means of 2409 pg/mL vs 1074 pg/mL, respectively). In comparison with current guidelines, the proposed cut-off values for ruling out heart failure were higher in the analyzed studies, with ranges of 230-760 pg/mL for NT-proBNP and 50-115 pg/mL for BNP. NT-proBNP and BNP are used for screening heart failure in the nursing-home population. The current screening cut-off values are probably too low for use in nursing homes. Our most conservative estimation for ruling out heart failure is an NT-proBNP cut-off value of 230 pg/mL.
养老院人群中心力衰竭负担沉重，这归因于高龄和合并症。在该人群中，心力衰竭常常未被诊断或误诊，因此仍未得到治疗。我们综述了利钠肽生物标志物在养老院居民心力衰竭筛查中的应用。本研究按照Cochrane协作网的建议，采用系统评价和Meta分析的首选报告项目声明（PRISMA）进行，并已在系统评价的PROSPERO注册库中注册。检索了2000年至2019年3月的PubMed、Embase和Trip数据库，并辅以手工检索参考文献。纳入了调查养老院人群的研究。养老院居民中心力衰竭的患病率高于可比年龄的一般人群（分别为23%和10%）。养老院的误诊率在25%至76%之间。NT-proBNP是心力衰竭筛查中最常用的利钠肽生物标志物。心力衰竭居民的NT-proBNP平均值显著高于总体居民（合并均值分别为2409 pg/mL和1074 pg/mL）。与当前指南相比，分析研究中排除心力衰竭的建议临界值更高，NT-proBNP的范围为230 - 760 pg/mL，BNP的范围为50 - 115 pg/mL。NT-proBNP和BNP用于养老院人群心力衰竭的筛查。目前的筛查临界值可能过低，不适用于养老院。我们排除心力衰竭的最保守估计是NT-proBNP临界值为230 pg/mL。
