Variable characteristics and instructions given to panellists
| Variable | Characteristics and instructions |
|---|---|
| Presenting symptoms (onset within the proceeding 3 months) | Cough — productive/non productive, day and/or night |
| Ankle swelling — bilateral | |
| Dyspnoea — including exertional dyspnoea, dyspnoea at rest, orthopnoea, and/or paroxysmal nocturnal dyspnoea | |
| Fatigue/tiredness — related to exertion | |
| CVD/chest examination normal/abnormal) | An abnormal examination was defined as that which identified one or more of the following features:a |
| • Elevated jugular venous pressure | |
| • Arrhythmia — possible atrial fibrillation or tachycardia (rate 100/minute at rest) | |
| • Additional heart sounds — including S3, S4, and murmurs | |
| • Laterally displaced apical impulse | |
| • Lung crackles/crepitations | |
| Risk of CVD19 | The panellists were explicitly asked to base their understanding of low, intermediate, or high risk of CVD on the following considerations: |
| • Known JBS2 score (that is, taking into account age, sex, smoking status, blood pressure, cholesterol, and, perhaps, family history and ethnic origin). Based on the JBS2 score a 10-year CVD risk of <10% is categorised as ‘low’ whereas a 10-year CVD risk of >20% is categorised as ‘high’. Consideration could also be given to alcohol intake, body mass/build, and activity levels in estimating risk | |
| • Current treatments for hypertension, hyperlipidaemia, HIV and anti-psychotic medication affect risk of CVD; in general, individuals undergoing these treatments will be, at least, at an intermediate level of risk | |
| • Comorbidities: individuals with chronic kidney disease, autoimmune disorders (such as systemic lupus erythematosus and rheumatoid arthritis), and women after a premature menopause are, at least, at an intermediate level of risk | |
| • High risk: The following were assumed to be at high risk: | |
| — Cardiovascular history: that is, angina, myocardial infarction, stroke, transient ischaemic attack, or peripheral arterial disease | |
| — Diabetes (type 1 or type 2) in individuals over the age of 40 years | |
| — Familial hypercholesterolaemia | |
| ECG (normal/none or abnormal) | In considering this categorisation, panellists were asked to appreciate that a ‘normal’ ECG recording will, in most cases, exclude heart failure, but abnormalities might be subtle and unrecognised by generalists.20 |
| For the sake of this exercise, the panel was, therefore, asked to only consider an ECG as normal if it had (a) been reported by an individual with specialist skills in ECG interpretation, or (b) reported as ‘normal’ by an ECG machine with interpretative software | |
↵a Ankle oedema has not been listed here as it is covered in the presenting symptoms. CVD = cardiovascular disease. ECG = electrocardiogram. JBS = Joint British Societies.