REFER = REFer for EchocaRdiogram
MICE = male, infarction, creptiations, edema
Patient selection: adult in primary care
Outcome: echocardiography to exclude heart failure
MICE criteria for referral - one or more of the following:
(1) history of myocardial infarction
(2) basal crepitations
(3) ankle edema in a male
Serum NT-proBNP criteria for referral - one of the following:
(1) female, no ankle edema, serum NT-proBNP > 620-1060 pg/L
(2) female, ankle edema, serum NT-proBNP > 190-520 pg/mL
(3) male, no ankle edema, serum NT-proBNP > 390-660 pg/mL
Other guidance:
(1) ESC: symptoms plus serum NT-proBNP >= 125 pg/mL
(2) NICE: symptoms plus serum NT-proBNP >= 400 pg/mL
Performance:
• The MICE criteria alone had an area under the ROC of 0.54.
• MICE plus NT-proBNP had an area under the ROC of 0.68 to 0.71 depending on cutoff.
• ESC criteria had an area under the ROC curve of 0.72 (highest sensitivity but lowest specificity).
• NICE criteria had an area under the ROC curve of 0.84.
• The rules tended to be sensitive but not specific.
• The method and reference range for measuring serum NT-proBNP not reported.
