Proactive screening for symptoms: A simple method to improve early detection of unrecognized cardiovascular disease in primary care. Results from the Lifelines Cohort Study

Victor W. Zwartkruis; Amy Groenewegen; Frans H. Rutten; Monika Hollander; Arno W. Hoes; M. Yldau van der Ende; Pim van der Harst; Maarten Jan Cramer; Yvonne T. van der Schouw; Hendrik Koffijberg; Michiel Rienstra; Rudolf A. de Boer

doi:10.1016/j.ypmed.2020.106143

Proactive screening for symptoms: A simple method to improve early detection of unrecognized cardiovascular disease in primary care. Results from the Lifelines Cohort Study

Victor W. Zwartkruis, Amy Groenewegen, Frans H. Rutten, Monika Hollander, Arno W. Hoes, M. Yldau van der Ende, Pim van der Harst, Maarten Jan Cramer, Yvonne T. van der Schouw, Hendrik Koffijberg, Michiel Rienstra, Rudolf A. de Boer^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

8 Citations (Scopus)

Abstract

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.

Original language	English
Article number	106143
Journal	Preventive Medicine
Volume	138
DOIs	https://doi.org/10.1016/j.ypmed.2020.106143
Publication status	Published - Sept 2020
Externally published	Yes

Bibliographical note

Funding Information:
For the current manuscript, the authors declare no potential conflicts of interest. Outside of the submitted work, the authors disclose the following financial support: FHR reports unrestricted institutional grants from Boehringer Ingelheim, Bayer, Bristol-Myers Squibb-Pfizer, and Daiichi Sankyo. RAdB reports grants from the Dutch Heart Foundation [CVON DOSIS, grant 2014-40; CVON SHE-PREDICTS-HF, grant 2017-21; and CVON PREDICT2, grant 2018-30] and the European Research Council [SECRETE-HF, ERC-COG 818715]. The UMCG, which employs RAdB, has received research grants and/or fees from AstraZeneca, Abbott, Bristol-Myers Squibb, Novartis, Novo Nordisk, and Roche. RAdB reports speaker fees from Abbott, AstraZeneca, Novartis, and Roche.This work was supported by the Dutch Heart Foundation [CVON RED-CVD, grant 2017-11]. The sponsor played no role in the study design, data collection, data analysis, data interpretation, writing of the report, or decision to submit the article for publication.

Funding Information:
For the current manuscript, the authors declare no potential conflicts of interest. Outside of the submitted work, the authors disclose the following financial support: FHR reports unrestricted institutional grants from Boehringer Ingelheim , Bayer , Bristol-Myers Squibb-Pfizer , and Daiichi Sankyo . RAdB reports grants from the Dutch Heart Foundation [CVON DOSIS, grant 2014-40 ; CVON SHE-PREDICTS-HF, grant 2017-21 ; and CVON PREDICT2, grant 2018-30 ] and the European Research Council [SECRETE-HF, ERC-COG 818715 ]. The UMCG, which employs RAdB, has received research grants and/or fees from AstraZeneca, Abbott, Bristol-Myers Squibb, Novartis, Novo Nordisk, and Roche. RAdB reports speaker fees from Abbott, AstraZeneca, Novartis, and Roche.

Funding Information:
This work was supported by the Dutch Heart Foundation [CVON RED-CVD, grant 2017-11 ]. The sponsor played no role in the study design, data collection, data analysis, data interpretation, writing of the report, or decision to submit the article for publication.

Publisher Copyright:
© 2020 The Author(s)

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10.1016/j.ypmed.2020.106143

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Zwartkruis, V. W., Groenewegen, A., Rutten, F. H., Hollander, M., Hoes, A. W., van der Ende, M. Y., van der Harst, P., Cramer, M. J., van der Schouw, Y. T., Koffijberg, H., Rienstra, M., & de Boer, R. A. (2020). Proactive screening for symptoms: A simple method to improve early detection of unrecognized cardiovascular disease in primary care. Results from the Lifelines Cohort Study. Preventive Medicine, 138, Article 106143. https://doi.org/10.1016/j.ypmed.2020.106143

@article{8218b678f9504372a335cc49d44816f4,

title = "Proactive screening for symptoms: A simple method to improve early detection of unrecognized cardiovascular disease in primary care. Results from the Lifelines Cohort Study",

abstract = "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 {\textquoteleft}three-disease{\textquoteright} 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.",

author = "Zwartkruis, {Victor W.} and Amy Groenewegen and Rutten, {Frans H.} and Monika Hollander and Hoes, {Arno W.} and {van der Ende}, {M. Yldau} and {van der Harst}, Pim and Cramer, {Maarten Jan} and {van der Schouw}, {Yvonne T.} and Hendrik Koffijberg and Michiel Rienstra and {de Boer}, {Rudolf A.}",

note = "Funding Information: For the current manuscript, the authors declare no potential conflicts of interest. Outside of the submitted work, the authors disclose the following financial support: FHR reports unrestricted institutional grants from Boehringer Ingelheim, Bayer, Bristol-Myers Squibb-Pfizer, and Daiichi Sankyo. RAdB reports grants from the Dutch Heart Foundation [CVON DOSIS, grant 2014-40; CVON SHE-PREDICTS-HF, grant 2017-21; and CVON PREDICT2, grant 2018-30] and the European Research Council [SECRETE-HF, ERC-COG 818715]. The UMCG, which employs RAdB, has received research grants and/or fees from AstraZeneca, Abbott, Bristol-Myers Squibb, Novartis, Novo Nordisk, and Roche. RAdB reports speaker fees from Abbott, AstraZeneca, Novartis, and Roche.This work was supported by the Dutch Heart Foundation [CVON RED-CVD, grant 2017-11]. The sponsor played no role in the study design, data collection, data analysis, data interpretation, writing of the report, or decision to submit the article for publication. Funding Information: For the current manuscript, the authors declare no potential conflicts of interest. Outside of the submitted work, the authors disclose the following financial support: FHR reports unrestricted institutional grants from Boehringer Ingelheim , Bayer , Bristol-Myers Squibb-Pfizer , and Daiichi Sankyo . RAdB reports grants from the Dutch Heart Foundation [CVON DOSIS, grant 2014-40 ; CVON SHE-PREDICTS-HF, grant 2017-21 ; and CVON PREDICT2, grant 2018-30 ] and the European Research Council [SECRETE-HF, ERC-COG 818715 ]. The UMCG, which employs RAdB, has received research grants and/or fees from AstraZeneca, Abbott, Bristol-Myers Squibb, Novartis, Novo Nordisk, and Roche. RAdB reports speaker fees from Abbott, AstraZeneca, Novartis, and Roche. Funding Information: This work was supported by the Dutch Heart Foundation [CVON RED-CVD, grant 2017-11 ]. The sponsor played no role in the study design, data collection, data analysis, data interpretation, writing of the report, or decision to submit the article for publication. Publisher Copyright: {\textcopyright} 2020 The Author(s)",

year = "2020",

month = sep,

doi = "10.1016/j.ypmed.2020.106143",

language = "English",

volume = "138",

journal = "Preventive Medicine",

issn = "0091-7435",

publisher = "Academic Press",

}

Zwartkruis, VW, Groenewegen, A, Rutten, FH, Hollander, M, Hoes, AW, van der Ende, MY, van der Harst, P, Cramer, MJ, van der Schouw, YT, Koffijberg, H, Rienstra, M & de Boer, RA 2020, 'Proactive screening for symptoms: A simple method to improve early detection of unrecognized cardiovascular disease in primary care. Results from the Lifelines Cohort Study', Preventive Medicine, vol. 138, 106143. https://doi.org/10.1016/j.ypmed.2020.106143

Proactive screening for symptoms: A simple method to improve early detection of unrecognized cardiovascular disease in primary care. Results from the Lifelines Cohort Study. / Zwartkruis, Victor W.; Groenewegen, Amy; Rutten, Frans H. et al.
In: Preventive Medicine, Vol. 138, 106143, 09.2020.

Research output: Contribution to journal › Article › Academic › peer-review

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 - Funding Information: For the current manuscript, the authors declare no potential conflicts of interest. Outside of the submitted work, the authors disclose the following financial support: FHR reports unrestricted institutional grants from Boehringer Ingelheim, Bayer, Bristol-Myers Squibb-Pfizer, and Daiichi Sankyo. RAdB reports grants from the Dutch Heart Foundation [CVON DOSIS, grant 2014-40; CVON SHE-PREDICTS-HF, grant 2017-21; and CVON PREDICT2, grant 2018-30] and the European Research Council [SECRETE-HF, ERC-COG 818715]. The UMCG, which employs RAdB, has received research grants and/or fees from AstraZeneca, Abbott, Bristol-Myers Squibb, Novartis, Novo Nordisk, and Roche. RAdB reports speaker fees from Abbott, AstraZeneca, Novartis, and Roche.This work was supported by the Dutch Heart Foundation [CVON RED-CVD, grant 2017-11]. The sponsor played no role in the study design, data collection, data analysis, data interpretation, writing of the report, or decision to submit the article for publication. Funding Information: For the current manuscript, the authors declare no potential conflicts of interest. Outside of the submitted work, the authors disclose the following financial support: FHR reports unrestricted institutional grants from Boehringer Ingelheim , Bayer , Bristol-Myers Squibb-Pfizer , and Daiichi Sankyo . RAdB reports grants from the Dutch Heart Foundation [CVON DOSIS, grant 2014-40 ; CVON SHE-PREDICTS-HF, grant 2017-21 ; and CVON PREDICT2, grant 2018-30 ] and the European Research Council [SECRETE-HF, ERC-COG 818715 ]. The UMCG, which employs RAdB, has received research grants and/or fees from AstraZeneca, Abbott, Bristol-Myers Squibb, Novartis, Novo Nordisk, and Roche. RAdB reports speaker fees from Abbott, AstraZeneca, Novartis, and Roche. Funding Information: This work was supported by the Dutch Heart Foundation [CVON RED-CVD, grant 2017-11 ]. The sponsor played no role in the study design, data collection, data analysis, data interpretation, writing of the report, or decision to submit the article for publication. Publisher Copyright: © 2020 The Author(s)

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.

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DO - 10.1016/j.ypmed.2020.106143

M3 - Article

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AN - SCOPUS:85085661231

SN - 0091-7435

VL - 138

JO - Preventive Medicine

JF - Preventive Medicine

M1 - 106143

ER -

Proactive screening for symptoms: A simple method to improve early detection of unrecognized cardiovascular disease in primary care. Results from the Lifelines Cohort Study

Abstract

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