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The waiting game

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By Emma Wilkinson

A fifth of COPD patients without a diagnosis of heart failure have the disease and can be identified by a new risk score, a new study concludes.

Dutch researchers scored signs and symptoms of heart failure, BNP and ECG tests to provide a guide on when to refer COPD patients for echo.

Patients with a history of ischaemic heart disease and a laterally displaced apex beat were at 2.2-fold and 2.3-fold raised risk of heart failure respectively.

Increased BMI and heart rate were also predictive.

A patient with COPD who scored more than nine on the 14-point scale was 57.1 per cent likely to have heart failure, while someone who scored nine or less was 85.4 per cent likely not to have the disease (see box, below).

Study leader Dr Frans Rutten, senior investigator at the Julius Centre for Health Sciences and Primary Care in Utrecht, the Netherlands, said: 'The use of four clinical parameters, natriuretic peptide measurements and electrocardiography should indeed increase confidence about the diagnosis of heart failure and will help the GPs to decide about the need for additional echocardiography and prognosis-improving treatment.'

The study, published online by the BMJ this week, investigated heart failure signs and symptoms in 405 patients over the age of 65 with COPD who did not have a confirmed heart failure diagnosis. Some 20.5 per cent of patients were subsequently diagnosed.

Dr Strat Liddiard, CHD lead for Poole PCT and a GP in Poole, Dorset, said the results were interesting as only ischaemic heart disease had previously been shown to be predictive in COPD patients.

'It seems an excellent way of picking up more people, although the apex beat is difficult to find in patients with COPD.'

He added: 'But what really matters is getting an echo to people that need it. If you don't have any of those signs but the patient has deteriorated it shouldn't stop you referring anyway.'

Score for each indicator

History of IHD = 2

BMI >30kg/mg2 = 3

Laterally displaced apex beat = 3

Heart rate >90 beats/min = 2

NT-proBNP>14.75pmol/l = 4

Abnormal ECG = 3

Positive predictive value %

0 4.9

2-5 10.6

6-9 25.4

10-14 57.1

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