Value of Orthopnea, Paroxysmal Nocturnal Dyspnea, and Medications in Prospective Population Studies of Incident Heart Failure

O. James Ekundayo, Virginia J. Howard, Monika M. Safford, Leslie A. McClure, Donna Arnett, Richard M. Allman, George Howard, Ali Ahmed

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Prospective population studies of incident heart failure (HF) are often limited by difficulties in assembling HF-free cohorts. In this study, public-use copies of the Cardiovascular Health Study (CHS) data sets were used to determine the sensitivity, specificity, and positive and negative predictive values of orthopnea and paroxysmal nocturnal dyspnea (PND), with and without the use of medications used in CHS HF criteria (diuretics plus digoxin or vasodilators), in the diagnosis of prevalent HF and in the assembly of a relatively HF-free population. Of the 5,771 community-dwelling older adults aged ≥65 years, 803 had orthopnea, 660 had PND, 1,075 had either symptom, 388 had both symptoms, 547 were using HF medications, and 4,315 had neither symptom and were not using HF medications. Definite HF was centrally adjudicated in 272 participants. The sensitivity, specificity, and positive and negative predictive values for either orthopnea or PND were 52% (95% confidence interval [CI] 46% to 58%), 83% (95% CI 82% to 84%), 13% (95% CI 11% to 15%), and 97% (95% CI 97% to 98%), respectively, and those for either orthopnea or PND or the use of HF medications were 77% (95% CI 72% to 82%), 77% (95% CI 76% to 79%), 14% (95% CI 13% to 16%), and 99% (95% CI 98% to 99%), respectively. In conclusion, only <20% of those with either orthopnea or PND had definite HF, which limits their usefulness in the diagnosis of prevalent HF in the community. However, nearly 99% (negative predictive value) of those with neither symptom nor using HF medications also did not have HF, which may be useful as a simple and inexpensive tool in assembling relatively HF-free cohorts for prospective population studies of incident HF.

Original languageEnglish
Pages (from-to)259-264
Number of pages6
JournalAmerican Journal of Cardiology
Volume104
Issue number2
DOIs
StatePublished - Jul 15 2009

Bibliographical note

Funding Information:
Dr. Ahmed is supported by the National Institutes of Health, Bethesda, Maryland, through Grant R01-HL085561 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland, and a generous gift from Jean B. Morris of Birmingham, Alabama. Dr. Safford is supported by Grant NIH R01 HL80477-01A1 from the National Heart, Lung, and Blood Institute. Dr. Allman is supported by grant P30AG031054 from the National Institute on Aging.

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of 'Value of Orthopnea, Paroxysmal Nocturnal Dyspnea, and Medications in Prospective Population Studies of Incident Heart Failure'. Together they form a unique fingerprint.

Cite this