An electronic strategy to identify hospitalized heart failure patients.
BACKGROUND
A common challenge in improving performance measures regarding heart failure (HF) is identifying patients early in the course of their hospitalization so that multidisciplinary education and clinical interventions can be implemented. We describe the accuracy of using an electronic pharmacy-based strategy to identify hospitalized patients likely to have a principal diagnosis of HF at discharge.


METHODS
We evaluated 2 strategies. The first used the receipt of an intravenous loop diuretic as a single predictor; the second incorporated additional lab, pharmacy, and demographic information in a multivariable general estimating equation.


RESULTS
Receipt of an intravenous diuretic predicted a discharge diagnosis of heart failure with a sensitivity of 0.89 and a specificity of 0.87. Adding age, B-type natriuretic peptide level, previous hospitalizations, attending physician specialty, and receipt of spironolactone into the predictor improved the sensitivity to 0.91 and the specificity to 0.89.


CONCLUSIONS
The receipt of intravenous loop diuretics is a reasonable and easily implemented screening test to identify patients likely to have a principal diagnosis of heart failure at discharge. The accuracy is improved by incorporating other electronically available variables.
Halasyamani
Lakshmi K
LK
Department of Internal Medicine, Saint Joseph Mercy Hospital, Ann Arbor, Michigan 48197, USA. Halasyal@trinity-health.org
Czerwinski
Jennifer
J
Clinard
Rosemary
R
Cowen
Mark E
ME
D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D006760:Hospitalization; D006764:Hospitals, Community / Q000379:methods; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010607:Pharmacy Service, Hospital / Q000379:methods*; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use
D049994:Sodium Potassium Chloride Symporter Inhibitors