Chronic heart failure in the community: Missed diagnosis and missed opportunities

Akosah, Kwame O.; Moncher, Karen; Schaper, Ana M.; Havlik, Paul; Devine, Stephen

doi:10.1054/jcaf.2001.26905

Cited by 34 publications

(17 citation statements)

References 34 publications

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“…Our results also support the previous finding that, within patients admitted with complains of shortness of breath but discharged without a diagnosis of HF, 44% had left ventricular ejection fraction V40% and 51% met the Framingham criteria for HF diagnosis [35]. The selection of btrue HF casesQ implies the exclusion of mild cases as suggested by the increased SMR and the shape of survival curves of patients with signs and symptoms of HF or cardiac abnormalities without a definite diagnosis of the disease.…”

Section: Discussionsupporting

confidence: 90%

Incidence and outcome of persons with a clinical diagnosis of heart failure in a general practice population of 696,884 in the United Kingdom

Giuli

Khaw

Cowie

et al. 2005

European Journal of Heart Failure

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Background: There are few large population-based studies of the incidence and outcome of heart failure where the diagnosis of heart failure (HF) has been made by a General Practitioner (GP) in the community. Methods: From the General Practice Research Database in the UK, we selected a population of 686,884 people 45 years or older. Incident cases of HF in 1991 were classified definite HF, possible HF, or a first prescription of diuretics without a diagnosis of HF. The population was followed for 3-year mortality. Results: A total of 6478 patients had definite HF (mean age 77.2 years, 55.5% women), 14,050 had possible HF and 6076 persons were prescribed diuretics without a definite or possible diagnosis of HF. The overall incidence of definite HF was 9.3/1000 persons/year and of possible HF 20.2/1000 persons/year. Diuretics were prescribed for the first time for other reasons for 8.7 persons/1000/year. The incidence of HF was higher in men. The incidence of definite HF increased with age. Survival curves showed higher mortality rates in the first 3 months after the diagnosis of HF. One-year cumulative probability of death for patients with definite HF was 15.9 times higher in men and 14.7 times higher in women in comparison with the UK population. Conclusion: The diagnosis of HF by a GP successfully identifies patients at high risk of death, comparable to patients with HF identified by cardiologists on the basis of defined diagnostic criteria. HF is common in the general population, increases sharply with age, and has a poor prognosis.

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Section: Discussionsupporting

confidence: 90%

Incidence and outcome of persons with a clinical diagnosis of heart failure in a general practice population of 696,884 in the United Kingdom

Giuli

Khaw

Cowie

et al. 2005

European Journal of Heart Failure

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“…For population surveillance, those admitted to the hospital with HF will most likely represent severe cases of the disease in the late stages of the diagnosis; therefore, relying solely on the HF-defining ICD codes (428 or I50) in hospital discharge data will underestimate the prevalence of disease (32,33). For the majority of studies reviewed, hospital discharge data were the primary administrative data source used for validation.…”

Section: Discussionmentioning

confidence: 99%

“…Eight studies (15,(25)(26)(27)(28)(29)(30)(31) ascertained HF presence based on diagnostic criteria used by scoring systems from Framingham, Carlson, Boston, the National Health and Nutrition Examination Survey (NHANES), the New York Heart Association (NYHA) or the European Society of Cardiology (ESC). Four studies (25)(26)(27)32) further classified HF according to levels of evidence such as definite or possible HF using the ESC or Boston criteria. Two studies compared the PPV against different clinical definitions of HF, and found that the PPV varied between criteria used (Lee et al [30], 94% Framingham versus 89% Carlson; McCullough et al [31], 56% NHANES versus 64% Framingham versus 83% NYHA).…”

Section: Literature Reviewmentioning

confidence: 99%

Administrative data have high variation in validity for recording heart failure

Quach

Blais

Quan

2010

Canadian Journal of Cardiology

129

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H eart failure (HF) has been widely studied because of its high mortality and morbidity rates (1-4). Studies on HF have relied on multiple data sources such as surveys, disease registries, hospital charts and administrative data. Of these sources, administrative data have been increasingly used for health services utilization and outcome evaluation.Administrative data result from implementing health care delivery, enrolling members into health insurance plans and reimbursing health care providers for services (5). The types of administrative data depend on the health care system and the funding structure. For example, Canada has a nationally funded health care system that collects hospital discharge data at a national level, while insurance registry, physician services and emergency room visit information is collected at a provincial level. Although these data are not intended for research, they are widely used in surveillance and outcome studies. Therefore, the validity of the research results rely on the quality of the data. Data quality is critical for interpreting variation across studies from different geographical areas.The purpose of the present study was to systematically review the literature pertaining to the validity of administrative data for recording HF and apply the International Classification of Diseases (ICD) HF definitions to Canadian hospital discharge abstract data to explore the prevalence of HF across ICD code definitions. METHODSLiterature review Search strategy: Only English language articles that compared the validity of ICD codes in administrative databases (eg, physician claims data, hospital discharge) with a reference standard (eg, chart review, registry, survey, case notes) were included. The literature search focused on articles published from 1990 to 2008. To identify peerreviewed journal articles, both the Ovid MEDLINE database and EMBASE were searched. Because validation studies were not indexed consistently with standard MeSH terms, the following key search terms were used: 'admin data', 'administrative data', 'population surveillance', 'heart failure', 'congestive heart failure', 'hospital data', 'physician claims', 'claims', 'hospital discharge', 'validation' and 'registries'. Next, Boolean operators were used to join search terms within the database search engines to locate articles. The reference lists from these articles were scanned to identify any additional articles that met heAlth outcomes/public policy ©2010 Pulsus Group Inc. All rights reserved Twenty-one studies validated hospital discharge abstract data; three studies validated physician claims and two studies validated ambulatory care data. Eighteen studies reported sensitivity (range 29% to 89%). Specificity and negative predictive value were greater than 70% across 17 studies. Nineteen studies reported positive predictive values (range 12% to 100%). Ten studies reported kappa values (range 0.39 to 0.84).

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“…1 Critical value at p 5 0.001: 10.827. 2 Excludes members with history of renal failure and members with medication allergy to ACE inhibitors who are not taking an angiotensin receptor blocker or a combination of hydralazine and nitrates. farction, significance was borderline at the p , 0.05 level.…”

Section: Appropriate Low-density Lipoprotein Cholesterol (Ldl-c) Scrementioning

confidence: 99%

“…In one retrospective review of 225 randomly selected patients, investigators concluded that many patients admitted with shortness of breath and low left ventricular ejection fraction had HF but are not diagnosed. 2 A patient's prospects for survival following a diagnosis of HF are bleaker than those for most forms of cancer. HF carries an overall mortality rate of 50% within 5 years of diagnosis.…”

Section: Introductionmentioning

confidence: 99%

The Effectiveness of Heart Failure Disease Management: Initial Findings from a Comprehensive Program

Clarke¹,

Nash²

2002

Disease Management

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Chronic heart failure in the community: Missed diagnosis and missed opportunities

Cited by 34 publications

References 34 publications

Incidence and outcome of persons with a clinical diagnosis of heart failure in a general practice population of 696,884 in the United Kingdom

Incidence and outcome of persons with a clinical diagnosis of heart failure in a general practice population of 696,884 in the United Kingdom

Administrative data have high variation in validity for recording heart failure

The Effectiveness of Heart Failure Disease Management: Initial Findings from a Comprehensive Program

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