TY - JOUR
T1 - Proactive screening for symptoms
T2 - A simple method to improve early detection of unrecognized cardiovascular disease in primary care. Results from the Lifelines Cohort Study
AU - Zwartkruis, Victor W.
AU - Groenewegen, Amy
AU - Rutten, Frans H.
AU - Hollander, Monika
AU - Hoes, Arno W.
AU - van der Ende, M. Yldau
AU - van der Harst, Pim
AU - Cramer, Maarten Jan
AU - van der Schouw, Yvonne T.
AU - Koffijberg, Hendrik
AU - Rienstra, Michiel
AU - de Boer, Rudolf A.
N1 - Elsevier deal
PY - 2020/9
Y1 - 2020/9
N2 - Cardiovascular disease (CVD) often goes unrecognized, despite symptoms frequently being present. Proactive screening for symptoms might improve early recognition and prevent disease progression or acute cardiovascular events. We studied the diagnostic value of symptoms for the detection of unrecognized atrial fibrillation (AF), heart failure (HF), and coronary artery disease (CAD) and developed a corresponding screening questionnaire. We included 100,311 participants (mean age 52 ± 9 years, 58% women) from the population-based Lifelines Cohort Study. For each outcome (unrecognized AF/HF/CAD), we built a multivariable model containing demographics and symptoms. These models were combined into one ‘three-disease’ diagnostic model and questionnaire for all three outcomes. Results were validated in Lifelines participants with chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM). Unrecognized CVD was identified in 1325 participants (1.3%): AF in 131 (0.1%), HF in 599 (0.6%), and CAD in 687 (0.7%). Added to age, sex, and body mass index, palpitations were independent predictors for unrecognized AF; palpitations, chest pain, dyspnea, exercise intolerance, health-related stress, and self-expected health worsening for unrecognized HF; smoking, chest pain, exercise intolerance, and claudication for unrecognized CAD. Area under the curve for the combined diagnostic model was 0.752 (95% CI 0.737–0.766) in the total population and 0.757 (95% CI 0.734–0.781) in participants with COPD and DM. At the chosen threshold, the questionnaire had low specificity, but high sensitivity. In conclusion, a short questionnaire about demographics and symptoms can improve early detection of CVD and help pre-select people who should or should not undergo further screening for CVD.
AB - Cardiovascular disease (CVD) often goes unrecognized, despite symptoms frequently being present. Proactive screening for symptoms might improve early recognition and prevent disease progression or acute cardiovascular events. We studied the diagnostic value of symptoms for the detection of unrecognized atrial fibrillation (AF), heart failure (HF), and coronary artery disease (CAD) and developed a corresponding screening questionnaire. We included 100,311 participants (mean age 52 ± 9 years, 58% women) from the population-based Lifelines Cohort Study. For each outcome (unrecognized AF/HF/CAD), we built a multivariable model containing demographics and symptoms. These models were combined into one ‘three-disease’ diagnostic model and questionnaire for all three outcomes. Results were validated in Lifelines participants with chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM). Unrecognized CVD was identified in 1325 participants (1.3%): AF in 131 (0.1%), HF in 599 (0.6%), and CAD in 687 (0.7%). Added to age, sex, and body mass index, palpitations were independent predictors for unrecognized AF; palpitations, chest pain, dyspnea, exercise intolerance, health-related stress, and self-expected health worsening for unrecognized HF; smoking, chest pain, exercise intolerance, and claudication for unrecognized CAD. Area under the curve for the combined diagnostic model was 0.752 (95% CI 0.737–0.766) in the total population and 0.757 (95% CI 0.734–0.781) in participants with COPD and DM. At the chosen threshold, the questionnaire had low specificity, but high sensitivity. In conclusion, a short questionnaire about demographics and symptoms can improve early detection of CVD and help pre-select people who should or should not undergo further screening for CVD.
KW - UT-Hybrid-D
KW - Cardiovascular diseases
KW - Cohort studies
KW - Coronary artery disease
KW - Diagnostic screening programs
KW - Early diagnosis
KW - Heart failure
KW - Primary health care
KW - Signs and symptoms
KW - Atrial fibrillation
UR - http://www.scopus.com/inward/record.url?scp=85085661231&partnerID=8YFLogxK
U2 - 10.1016/j.ypmed.2020.106143
DO - 10.1016/j.ypmed.2020.106143
M3 - Article
C2 - 32473262
AN - SCOPUS:85085661231
VL - 138
JO - Preventive medicine
JF - Preventive medicine
SN - 0091-7435
M1 - 106143
ER -