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MICE or NICE? An economic evaluation of clinical decision rules in the diagnosis of heart failure in primary care

Overview of attention for article published in International Journal of Cardiology, August 2017
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • Good Attention Score compared to outputs of the same age (78th percentile)
  • High Attention Score compared to outputs of the same age and source (88th percentile)

Mentioned by

policy
1 policy source
twitter
7 tweeters

Citations

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2 Dimensions

Readers on

mendeley
35 Mendeley
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Title
MICE or NICE? An economic evaluation of clinical decision rules in the diagnosis of heart failure in primary care
Published in
International Journal of Cardiology, August 2017
DOI 10.1016/j.ijcard.2017.02.149
Pubmed ID
Authors

Mark Monahan, Pelham Barton, Clare J Taylor, Andrea K Roalfe, F.D. Richard Hobbs, Martin Cowie, Russell Davis, Jon Deeks, Jonathan Mant, Deborah McCahon, Theresa McDonagh, George Sutton, Lynda Tait

Abstract

Detection and treatment of heart failure (HF) can improve quality of life and reduce premature mortality. However, symptoms such as breathlessness are common in primary care, have a variety of causes and not all patients require cardiac imaging. In systems where healthcare resources are limited, ensuring those patients who are likely to have HF undergo appropriate and timely investigation is vital. A decision tree was developed to assess the cost-effectiveness of using the MICE (Male, Infarction, Crepitations, Edema) decision rule compared to other diagnostic strategies to identify HF patients presenting to primary care. Data from REFER (REFer for EchocaRdiogram), a HF diagnostic accuracy study, was used to determine which patients received the correct diagnosis decision. The model adopted a UK National Health Service (NHS) perspective. The current recommended National Institute for Health and Care Excellence (NICE) guidelines for identifying patients with HF was the most cost-effective option with a cost of £4400 per quality adjusted life year (QALY) gained compared to a "do nothing" strategy. That is, patients presenting with symptoms suggestive of HF should be referred straight for echocardiography if they had a history of myocardial infarction or if their NT-proBNP level was ≥400pg/ml. The MICE rule was more expensive and less effective than the other comparators. Base-case results were robust to sensitivity analyses. This represents the first cost-utility analysis comparing HF diagnostic strategies for symptomatic patients. Current guidelines in England were the most cost-effective option for identifying patients for confirmatory HF diagnosis. The low number of HF with Reduced Ejection Fraction patients (12%) in the REFER patient population limited the benefits of early detection.

Twitter Demographics

The data shown below were collected from the profiles of 7 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 35 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 3%
Unknown 34 97%

Demographic breakdown

Readers by professional status Count As %
Researcher 12 34%
Unspecified 4 11%
Student > Ph. D. Student 4 11%
Student > Master 4 11%
Other 4 11%
Other 7 20%
Readers by discipline Count As %
Medicine and Dentistry 16 46%
Unspecified 7 20%
Psychology 2 6%
Computer Science 2 6%
Agricultural and Biological Sciences 1 3%
Other 7 20%

Attention Score in Context

This research output has an Altmetric Attention Score of 8. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 12 September 2018.
All research outputs
#2,048,427
of 13,500,498 outputs
Outputs from International Journal of Cardiology
#473
of 5,660 outputs
Outputs of similar age
#57,086
of 263,963 outputs
Outputs of similar age from International Journal of Cardiology
#12
of 105 outputs
Altmetric has tracked 13,500,498 research outputs across all sources so far. Compared to these this one has done well and is in the 84th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 5,660 research outputs from this source. They receive a mean Attention Score of 4.0. This one has done particularly well, scoring higher than 91% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 263,963 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 78% of its contemporaries.
We're also able to compare this research output to 105 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 88% of its contemporaries.