This Article Abstract Full Text Full Text (PDF) Online Appendix 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 Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Steinhart, B. Articles by Mazer, C. D. Search for Related Content PubMed PubMed Citation Articles by Steinhart, B. Articles by Mazer, C. D. Related Collections Related Articles

Improving the Diagnosis of Acute Heart Failure Using a Validated Prediction Model

Brian Steinhart, MD^_*,,_*, Kevin E. Thorpe, MMath^,_**, Ahmed M. Bayoumi, MD^_*,,||,, Gordon Moe, MD^_*,,¶, James L. Januzzi, Jr, MD and C. David Mazer, MD^,,#

^_* Department of Medicine, Saint Michael's Hospital, Toronto, Ontario, Canada
Department of Anesthesia and Critical Care Medicine, Saint Michael's Hospital, Toronto, Ontario, Canada
Keenan Research Center/Li Ka Shing Knowledge Institute, Saint Michael's Hospital, Toronto, Ontario, Canada
Department of Medicine, Division of Emergency Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
^|| Department of Medicine, Division of General Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
^¶ Department of Medicine, Division of Cardiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
^# Departments of Anesthesia and Physiology, Faculty of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
^_** Faculty of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
Faculty of Medicine, Department of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts

View larger version (14K): [in this window] [in a new window] [Download PPT slide]   Figure 1 Comparison of NT-proBNP Levels With Physician Estimate of Pre-Test Probability of AHF AHF = acute heart failulre; NT-proBNP = N-terminal pro–B-type natriuretic peptide.

View larger version (26K): [in this window] [in a new window] [Download PPT slide]   Figure 2 Utility of Multiple NT-proBNP Cut Point Values for Altering Pre-Test Probability for AHF Based on Likelihood Ratios Points further from the hypothetical null diagonal enhance change in pre-test probability. Points below it are in the rule-out AHF zone, points above it are in the rule-in zone, and points further from the diagonal in either direction enhance change in pre-test probability. Thus, the interval of <300 pg/ml has good rule-out AHF utility, and much less so the 300 to 899 pg/ml interval. Increasing the number of intervals for the greater NT-proBNP values adds incremental rule in AHF utility. Patients with pre-test probabilities 20% or 80% demonstrate minimal change in post-test results regardless of range of cut point. Patients with pre-test probabilities between 20% and 80% demonstrate the greatest change in post-test results. Abbreviations as in Figure 1.