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

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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Abstract

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 resultsA 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. ConclusionsA 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.

Original languageEnglish
Pages (from-to)1000-1008
Number of pages9
JournalEuropean Journal of Heart Failure
Volume14
Issue number9
DOIs
Publication statusPublished - Sep 2012

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Infarction
Edema
Primary Health Care
Heart Failure
Echocardiography
Natriuretic Peptides
Calibration
Referral and Consultation
Logistic Models
Myocardial Infarction
Decision Support Techniques
Ankle
ROC Curve
Lung
Datasets

Cite this

Roalfe, Andrea K. ; Mant, Jonathan ; Doust, Jenny A. ; Barton, Pelham ; Cowie, Martin R. ; Glasziou, Paul ; Mant, David ; McManus, Richard J. ; Holder, Roger ; Deeks, Jonathan J. ; Doughty, Robert N. ; Hoes, Arno W. ; Fletcher, Kate ; Hobbs, F. D Richard. / 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. In: European Journal of Heart Failure. 2012 ; Vol. 14, No. 9. pp. 1000-1008.
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abstract = "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 resultsA 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. ConclusionsA 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.",
author = "Roalfe, {Andrea K.} and Jonathan Mant and Doust, {Jenny A.} and Pelham Barton and Cowie, {Martin R.} and Paul Glasziou and David Mant and McManus, {Richard J.} and Roger Holder and Deeks, {Jonathan J.} and Doughty, {Robert N.} and Hoes, {Arno W.} and Kate Fletcher and Hobbs, {F. D Richard}",
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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. / Roalfe, Andrea K.; Mant, Jonathan; Doust, Jenny A.; Barton, Pelham; Cowie, Martin R.; Glasziou, Paul; Mant, David; McManus, Richard J.; Holder, Roger; Deeks, Jonathan J.; Doughty, Robert N.; Hoes, Arno W.; Fletcher, Kate; Hobbs, F. D Richard.

In: European Journal of Heart Failure, Vol. 14, No. 9, 09.2012, p. 1000-1008.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Development and initial validation of a simple clinical decision tool to predict the presence of heart failure in primary care

T2 - The MICE (Male, Infarction, Crepitations, Edema) rule

AU - Roalfe, Andrea K.

AU - Mant, Jonathan

AU - Doust, Jenny A.

AU - Barton, Pelham

AU - Cowie, Martin R.

AU - Glasziou, Paul

AU - Mant, David

AU - McManus, Richard J.

AU - Holder, Roger

AU - Deeks, Jonathan J.

AU - Doughty, Robert N.

AU - Hoes, Arno W.

AU - Fletcher, Kate

AU - Hobbs, F. D Richard

PY - 2012/9

Y1 - 2012/9

N2 - 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 resultsA 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. ConclusionsA 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.

AB - 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 resultsA 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. ConclusionsA 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.

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U2 - 10.1093/eurjhf/hfs089

DO - 10.1093/eurjhf/hfs089

M3 - Article

VL - 14

SP - 1000

EP - 1008

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

IS - 9

ER -