Nurses' performance in classifying heart failure patients based on physical exam : comparison with cardiologist's physical exam and levels of N-terminal pro-B-type natriuretic peptide

Abstract

Aim.The purpose of this study is to compare clinical assessment of congestion performed by a nurse to that performed bycardiologist and correlate them with NT-ProBNP levels.Background.The nurses’ role in heart failure has been strongly focused in therapeutic, educational and self-care interventions.The diagnostic performance of nurses in heart failure outpatients is not well explored. N-terminal pro-B-type natriuretic peptideis a cardiac marker that reflects elevated filling pressures.Design.Cross-sectional contemporaneous study.Methods.Heart failure outpatients underwent a systematic clinical assessment of clinical congestion score performed by car-diologist and nurse during the same visit. Assessments were performed independently and N-terminal pro-B-type natriureticpeptide levels obtained. The nurses’ ability to classify patients in hemodynamic profile was compared to the cardiologist’s.Results.Eighty-nine assessments were performed in 63 patients with heart failure. The correlation of clinical congestion scoresobtained by nurse with those obtained by cardiologist wasrs=0Æ86;p<0Æ001. The correlation of clinical congestion scoresfrom nurse and cardiologist with levels of N-terminal pro-B-type natriuretic peptide were as follows:rs=0Æ45;p<0Æ0001 andrs=0Æ51, respectively,p<0Æ0001. Patients with clinical congestion score‡3 had levels of NT-ProBNP significantly higher thanthose with clinical congestion score<3, in the assessment performed by the cardiologist (1866 SD 1151 vs. 757 SD 988 pg/ml;p<0Æ0001) and by the nurse (1720 SD 1228 vs. 821 SD 914 pg/ml;p<0Æ0001). The nurse and cardiologist had similarcapacity in classifying patients in congested quadrants (p=0Æ027) or in dry quadrants (p=0Æ03), according to the levels ofN-terminal pro-B-type natriuretic peptide. Area under the receiver-operating characteristic curve of the nurse and cardiologist todetect congestion was, respectively, 0Æ77 and 0Æ72. Conclusions.Our data suggests that nurses trained in heart failure may have a similar performance to that of the cardiologistfor the clinical detection of congestion and assessment of the hemodynamic profile in patients with chronic heart failure.