Similar incidence of over and underdiagnosis of heart failure in hospitalized patients with type 2 diabetes mellitus

Abstract

Purpose To assess the incidence of over and underdiagnosis of heart failure (HF) in hospital patients with type 2 diabetes mellitus (T2DM) Methods In the single-center prospective study (registry) from 01.08.2018 to 31.01.2019 we included 1008 patients admitted to the city hospital. Key inclusion criteria: a history of T2DM, age ≥40 years. Key exclusion criteria: any other disorders of carbohydrate metabolism, age <40 years, acute coronary syndrome, functionally dependent patients. We assessed the presence of HF in the diagnosis at admission by the following criteria: the presence of HF stage C or D (ACCF/AHA) and at least II NYHA functional class. All patients underwent standard echocardiography and NT-proBNP assessment at 1–3 days after admission. The diagnosis of HF was established by the 2016 ESC HF Guidelines. After the examination, the patients were divided into subgroups: “Confirmed HF” (HF was in the diagnosis, its presence was confirmed), “Unconfirmed HF” (HF was in the diagnosis, its presence was excluded), “First diagnosed HF” (HF was not in the diagnosis, its presence was confirmed) and “Absent of HF” (HF was not in the diagnosis and its presence was excluded). We also analyzed the reasons for admissions in all patients. Results The presence of HF in the diagnosis at admission was in 68.8% (n=693) of patients and, accordingly, it was absent in 31.2% (n=315). By the ESC HF Guidelines HF was diagnosed in 68.1% (n=686) and, accordingly, in 31.9% (n=322) it was excluded. The analysis results by the diagnosis at admission are presented in Fig. 1. The analysis of the reasons for admission depending on the HF status is presented in Fig. 2. In 35 patients admitted with HF decompensation the presence of HF was not confirmed and the diagnosis was revised: atrial fibrillation in 11 (31,4%) patients, exacerbation of COPD – 7 (20,0%), pulmonary embolism – 6 (17,1%), pneumonia – 4 (11,4%), kidney diseases – 4 (11,4%), and asthma – 3 (8,7%). Conclusion Among hospitalized patients with T2DM, there is a similar incidence of over and underdiagnosis of HF. Patients with first diagnosed HF were more likely to be admitted for reasons unrelated to cardiovascular diseases (CVD), most often with hyperglycemia (Fig. 2). Patients with unconfirmed HF – for reasons related to CVD, while the reason for admission in a quarter of patients was HF decompensation (Fig. 2). Despite the availability of examination for HF, the problem of its diagnosis is still relevant. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Improving Fairness in the Prediction of Heart Failure Length of Stay and Mortality by Integrating Social Determinants of Health

“…In real-world settings, underdiagnosis of HF may delay patients' access to care and is associated with a higher risk of 30-day readmission, 37,38 whereas overdiagnosis of HF may result in inappropriate patient management. 39 ML classifiers have frequently perpetuated these biases in diagnosis and may have contributed to confusion regarding racial and socioeconomic disparities.…”