HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Di Bari, M. Articles by Marchionni, N. Search for Related Content PubMed PubMed Citation Articles by Di Bari, M. Articles by Marchionni, N.

HEART FAILURE

The diagnosis of heart failure in the community

Comparative validation of four sets of criteria in unselected older adults: the ICARe Dicomano Study

Mauro Di Bari, MD, PhD^*,,*, Claudia Pozzi, MD^*, Maria Chiara Cavallini, MD, PhD^*,, Francesca Innocenti, MD^*,, Giorgio Baldereschi, MD^*,, Walter De Alfieri, MD, Enrico Antonini, MS^*, Riccardo Pini, MD, FACC^*,, Giulio Masotti, MD^*, and Niccolò Marchionni, MD^*,

^* Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence
Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
Unit of Geriatrics, Grosseto, Italy

Manuscript received April 16, 2004; revised manuscript received June 24, 2004, accepted July 5, 2004.

^* Reprint requests and corresponence: Dr. Mauro Di Bari, Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence, via delle Oblate, 4, 50141 Florence, Italy (Email: dibari{at}unifi.it).

OBJECTIVES: We sought to compare construct and predictive validity of four sets of heart failure (HF) diagnostic criteria in an epidemiologic setting.

BACKGROUND: The prevalence estimates of HF vary broadly depending on the diagnostic criteria.

METHODS: Data were collected in a survey of community dwellers who were 65 years of age living in Dicomano, Italy. At baseline, HF was diagnosed with the criteria of the Framingham, Boston, and Gothenburg studies and of the European Society of Cardiology (ESC). Left ventricular mass index and ejection fraction, left atrium systolic dimension, lower extremity mobility disability, summary physical performance score, and 6-min walk test were compared between HF and non-HF participants to test for construct validity of each set of criteria. Predictive validity was evaluated with follow-up assessment of cardiovascular mortality, incident disability, and HF-related hospitalizations. Comparisons were adjusted for demographics, comorbidity, and psychoaffective status.

RESULTS: Of 553 participants, 11.9%, 10.7%, 20.8%, and 9.0% had HF, according to Framingham, Boston, Gothenburg, and ESC criteria, respectively. In terms of construct validity, Framingham and Boston criteria discriminated HF from non-HF participants better than Gothenburg and ESC criteria across the measures of cardiac function and global performance. The Boston criteria showed a superior predictive validity because they indicated a significantly greater adjusted risk of cardiovascular death (hazard ratio3.9, 95% confidence interval 1.2 to 13.2), incident disability, and hospitalizations in participants with HF.

CONCLUSIONS: The Boston criteria are preferable to Framingham, Gothenburg, and ESC criteria for the diagnosis of HF in older community dwellers because they have good construct validity and more accurately predict cardiovascular death, incident disability, and hospitalizations.

Abbreviations and Acronyms   BADL = basic activities of daily living   ESC = European Society of Cardiology   GDS = Geriatric Depression Scale   HF = heart failure   ICED = Index of Coexisting Diseases   LASD = left atrial systolic dimension   LEMD = lower extremity mobility disability   LV = left ventricular   LVEF = left ventricular ejection fraction   LVMI = left ventricular mass index   MMSE = Mini Mental State Examination   SPS = summary performance score   6MWT = 6-min walk test

This article has been cited by other articles:

				D. M. Henkel, M. M. Redfield, S. A. Weston, Y. Gerber, and V. L. Roger Death in Heart Failure: A Community Perspective Circ Heart Fail, July 1, 2008; 1(2): 91 - 97. [Abstract] [Full Text] [PDF]

				M. Inzitari, C. Pozzi, L. Ferrucci, D. Chiarantini, L. A. Rinaldi, M. Baccini, R. Pini, G. Masotti, N. Marchionni, and M. Di Bari Subtle Neurological Abnormalities as Risk Factors for Cognitive and Functional Decline, Cerebrovascular Events, and Mortality in Older Community-Dwelling Adults Arch Intern Med, June 23, 2008; 168(12): 1270 - 1276. [Abstract] [Full Text] [PDF]