Validation of heart failure diagnosis registered in primary care records in two primary care centres in Barcelona (Spain) and factors related. A cross-sectional study

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Abstract

Background: Heart failure (HF) diagnosis as reported in primary care medical records is not always properly confirmed and could result in over-registration.

Objectives: To determine the proportion of registered HF that can be confirmed with information from primary care medical records and to analyse related factors.

Methods: A cross-sectional study. The medical records of 595 HF patients attended in two primary healthcare centres in Barcelona (Spain) were revised and validated by a team of experts who classified diagnosis into confirmed, unconfirmed, and misdiagnosis. Variables potentially related to the confirmation of the diagnosis were analysed. The revision of medical records and data collection took place from 15 January to 31 March 2014.

Results: Mean (standard deviation) age was 78 (10) years and 58% were women. The diagnosis could be confirmed in 53.6% of patients. Factors associated with a greater probability of having a confirmed diagnosis were age (yearly OR: 0.97, 95%CI: 0.95–0.99), cardiologist follow-up (OR: 3.66, 95%CI: 2.46–5.48), history of ischaemic heart disease (OR: 2.18, 95%CI: 1.36–2.48), atrial fibrillation (OR: 2.01, 95%CI: 1.34–3.03), and prescription of loop diuretics (OR: 3.24, 95%CI: 2.14–4.89).

Conclusion: Only in half of the patients labelled as HF in primary care medical records could this diagnosis be further confirmed. Variables regularly registered in clinical practice could help general practitioners identify those patients requiring a revision of their HF diagnosis.

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Most cited references 23

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The EuroHeart Failure survey programme-- a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis.

J G F Cleland, K Swedberg, F Follath … (2003)

The European Society of Cardiology (ESC) has published guidelines for the investigation of patients with suspected heart failure and, if the diagnosis is proven, their subsequent management. Hospitalisation provides a key point of care at which time diagnosis and treatment may be refined to improve outcome for a group of patients with a high morbidity and mortality. However, little international data exists to describe the features and management of such patients. Accordingly, the EuroHeart Failure survey was conducted to ascertain if appropriate tests were being performed with which to confirm or refute a diagnosis of heart failure and how this influenced subsequent management. The survey screened consecutive deaths and discharges during 2000-2001 predominantly from medical wards over a 6-week period in 115 hospitals from 24 countries belonging to the ESC, to identify patients with known or suspected heart failure. A total of 46788 deaths and discharges were screened from which 11327 (24%) patients were enrolled with suspected or confirmed heart failure. Forty-seven percent of those enrolled were women. Fifty-one percent of women and 30% of men were aged >75 years. Eighty-three percent of patients had a diagnosis of heart failure made on or prior to the index admission. Heart failure was the principal reason for admission in 40%. The great majority of patients (>90%) had had an ECG, chest X-ray, haemoglobin and electrolytes measured as recommended in ESC guidelines, but only 66% had ever had an echocardiogram. Left ventricular ejection fraction had been measured in 57% of men and 41% of women, usually by echocardiography (84%) and was <40% in 51% of men but only in 28% of women. Forty-five percent of women and 22% of men were reported to have normal left ventricular systolic function by qualitative echocardiographic assessment. A substantial proportion of patients had alternative explanations for heart failure other than left ventricular systolic or diastolic dysfunction, including valve disease. Within 12 weeks of discharge, 24% of patients had been readmitted. A total of 1408 of 10434 (13.5%) patients died between admission and 12 weeks follow-up. Known or suspected heart failure comprises a large proportion of admissions to medical wards and such patients are at high risk of early readmission and death. Many of the basic investigations recommended by the ESC were usually carried out, although it is not clear whether this was by design or part of a general routine for all patients being admitted regardless of diagnosis. The investigation most specific for patients with suspected heart failure (echocardiography) was performed less frequently, suggesting that the diagnosis of heart failure is still relatively neglected. Most men but a minority of women who underwent investigation of cardiac function had evidence of moderate or severe left ventricular dysfunction, the main target of current advances in the treatment of heart failure. Considerable diagnostic uncertainty remains for many patients with suspected heart failure, even after echocardiography, which must be resolved in order to target existing and new therapies and services effectively.

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Identifying cases of congestive heart failure from administrative data: a validation study using primary care patient records.

Steve Rothwell, Domena Tu, Annette Schultz … (2013)

To determine if using a combination of hospital administrative data and ambulatory care physician billings can accurately identify patients with congestive heart failure (CHF), we tested 9 algorithms for identifying individuals with CHF from administrative data. The validation cohort against which the 9 algorithms were tested combined data from a random sample of adult patients from EMRALD, an electronic medical record database of primary care physicians in Ontario, Canada, and data collected in 2004/05 from a random sample of primary care patients for a study of hypertension. Algorithms were evaluated on sensitivity, specificity, positive predictive value, area under the curve on the ROC graph and the combination of likelihood ratio positive and negative. We found that that one hospital record or one physician billing followed by a second record from either source within one year had the best result, with a sensitivity of 84.8% and a specificity of 97.0%. Population prevalence of CHF can be accurately measured using combined administrative data from hospitalization and ambulatory care.

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Heart failure with preserved ejection fraction: a clinical dilemma.

Michel Komajda, Carolyn S. P. Lam (2014)

Heart failure with preserved ejection fraction (HFpEF) is now recognized as a major and growing public health problem worldwide. Yet significant uncertainties still surround its pathophysiology and treatment, leaving clinicians in a dilemma regarding its optimal management. Whether HFpEF and heart failure with reduced ejection fraction (HFrEF) are two distinct entities or two ends of a common spectrum remains a matter of debate. In particular, the lack of benefit observed with renin-angiotensin system blockers has raised questions regarding our understanding of the pathophysiology of HFpEF. New paradigms including a prominent role of co-morbidities, inflammation, endothelial dysfunction, and pro-hypertrophic signalling pathways have been proposed. Recent proof-of-concept trials using a phosphodiesterase inhibitor, a mineralocorticoid receptor antagonist, an angiotensin receptor/neprilysin inhibitor, a soluble guanylate cyclase stimulator, or a sino atria, if current blocker provide important insight for the development of novel therapeutic strategies in HFpEF.

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Author and article information

Journal

Journal ID (nlm-ta): Eur J Gen Pract

Journal ID (iso-abbrev): Eur J Gen Pract

Journal ID (archive): IGEN

Journal ID (publisher-id): igen20

Title: The European Journal of General Practice

Publisher: Taylor & Francis

ISSN (Print): 1381-4788

ISSN (Electronic): 1751-1402

Publication date Collection: 2017

Publication date (Electronic): 5 April 2017

Volume: 23

Issue: 1

Pages: 107-113

Affiliations

[ ^a ] Centro de Atención Primaria Sant Martí de Provençals, Institut Català de la Salut BarcelonaSpain

[ ^b ] Institut d’Investigació en Atenció Primaria IDIAP-Jordi Gol BarcelonaSpain

[ ^c ] Departament de Medicina, Facultat de Medicina , Universitat Autónoma de Barcelona BellaterraSpain

[ ^d ] Programa Integrado de Atención a la Insuficiencia Cardiaca del Área Integral de Salud Barcelona Litoral Mar, Servei Català de la Salut BarcelonaSpain

[ ^e ] Parc de Salut MAR, Servicio de Cardiologıa, Hospital del Mar BarcelonaSpain

[ ^f ] Centro de Atención Primaria Sant Roc, Institut Català de la Salut BadalonaSpain

[ ^g ] Centro de Atención Primaria Congres, Institut Català de la Salut BarcelonaSpain

[ ^h ] Departament de Obstericia, Ginecologia i Medicina Preventiva, Facultat de Medicina, Universidad Autónoma de Barcelona BellaterraSpain

Author notes

CONTACT Miguel Angel Muñoz Pérez mamunoz.bcn.ics@ 123456gencat.cat Head Primary Care Research Unit of Barcelona, Institut Català de la Salut, IDIAP-Jordi Gol Sardenya 375, Entlo| 08025 BarcelonaSpain

Article

Publisher ID: 1305104

DOI: 10.1080/13814788.2017.1305104

PMC ID: 5774267

PubMed ID: 28376668

SO-VID: 3f1712c8-4d10-441c-b137-1d053736622f

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 1 February 2016

Date revision received : 27 February 2017

Date accepted : 2 March 2017

Page count

Pages: 7, Words: 4124

Funding

Funded by: Primary Healthcare University Research Institute IDIAP Jordi Gol

This work was supported by Primary Healthcare University Research Institute IDIAP Jordi Gol, Barcelona, Spain.

Validation of heart failure diagnosis registered in primary care records in two primary care centres in Barcelona (Spain) and factors related. A cross-sectional study

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Cardiovascular Innovations and Applications

Most cited references 23

The EuroHeart Failure survey programme-- a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis.

Identifying cases of congestive heart failure from administrative data: a validation study using primary care patient records.

Heart failure with preserved ejection fraction: a clinical dilemma.

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