Document Detail

Development and initial validation of a simple clinical decision tool to predict the presence of heart failure in primary care: the MICE (Male, Infarction, Crepitations, Edema) rule.
MedLine Citation:
PMID:  22713289     Owner:  NLM     Status:  MEDLINE    
AIMS: Diagnosis of heart failure in primary care is often inaccurate, and access to and use of echocardiography is suboptimal. This study aimed to develop and provisionally validate a clinical prediction rule to optimize referral for echocardiography of people identified in primary care with suspected heart failure.
METHODS AND RESULTS: A systematic review identified studies of diagnosis of heart failure set in primary care. The individual patient data for five of these studies were obtained. Logistic regression models to predict heart failure were developed on one of the data sets and validated on the others using area under the receiver operating characteristic curve (AUROC), and goodness-of-fit calibration plots. A model based upon four simple clinical features (Male, history of myocardial Infarction, Crepitations, Edema: MICE) and natriuretic peptide had good validity when applied to other data sets, with AUROCs between 0.84 and 0.93, and reasonable calibration. The rule performed well across the data sets, with sensitivity between 81% and 96% and specificity between 57% and 74%.
CONCLUSIONS: A simple clinical rule based upon gender, history of myocardial infarction, presence of ankle oedema, and presence of basal lung crepitations can discriminate between people with suspected heart failure who should be referred straight for echocardiography and people for whom referral should depend upon the result of a natriuretic peptide test. Prospective validation and an implementation evaluation of the rule is now warranted.
Andrea K Roalfe; Jonathan Mant; Jenny A Doust; Pelham Barton; Martin R Cowie; Paul Glasziou; David Mant; Richard J McManus; Roger Holder; Jonathan J Deeks; Robert N Doughty; Arno W Hoes; Kate Fletcher; F D Richard Hobbs
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Validation Studies     Date:  2012-06-19
Journal Detail:
Title:  European journal of heart failure     Volume:  14     ISSN:  1879-0844     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-08-22     Completed Date:  2013-01-17     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1000-8     Citation Subset:  IM    
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MeSH Terms
Aged, 80 and over
Decision Support Techniques*
Edema / epidemiology
Heart Failure / diagnosis*
Logistic Models
Middle Aged
Myocardial Infarction / epidemiology
Natriuretic Peptide, Brain / diagnostic use
Primary Health Care*
Prospective Studies
ROC Curve
Referral and Consultation
Respiratory Sounds
Sensitivity and Specificity
Sex Factors
Grant Support
CDF/01/017//Department of Health
Reg. No./Substance:
114471-18-0/Natriuretic Peptide, Brain

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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