title: The Value of Admission Clinical Data for Diagnosing Heart Failure in Long-term Care.
abstract: BACKGROUND
  Heart failure (HF) is common in long-term care (LTC). Diagnostic uncertainty is important barrier to optimal HF management, stemming from inadequate health information transfer upon LTC admission. We determine the utility of admission clinical information to confirm a HF diagnosis in new LTC residents.
  
  
  METHODS
  This was a prospective cohort study. From February 2004 to November 2006, information about new residents from 41 LTC homes in Ontario, Canada, was collected from residents and caregivers, and all available health records. A prior HF diagnosis was confirmed by consensus review of available data by two independent experts. Multivariate modelling was utilized to determine the utility of the admission clinical assessment in confirming a prior HF diagnosis.
  
  
  RESULTS
  A total of 449 residents were included for analysis, aged 84.3±6.5 years, and 21.6% had a prior HF diagnosis. The most useful clinical item for diagnosing HF was a "history of HF". The final model included "history of HF' (OR [odds ratio] 13.66, 95% CI 6.61-28.24), "fluid on the lungs" (OR 2.01, 95% CI 1.04-3.89), "orthopnea" (OR 1.76, 95% CI 0.93-3.33), "taking β-blocker" (OR 2.09, 95% CI 1.10-3.94), "taking loop diuretics" (OR 2.11, 95% CI 1.12-3.98), and "history of coronary artery disease" (OR 2.83, 95% CI 1.42-5.64).
  
  
  CONCLUSIONS
  Elements of the clinical assessment for new LTC residents can help confirm a prior HF diagnosis. An admission history of HF is highly predictive.
authors.affiliation: Research Institute for Aging and School of Public Health and Health Systems, University of Waterloo, Kitchener, ON;
authors.forename: George A
authors.initials: GA
authors.lastname: Heckman
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Foebel
authors.forename: Joel A
authors.initials: JA
authors.lastname: Dubin
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ng
authors.forename: Irene D
authors.initials: ID
authors.lastname: Turpie
authors.forename: Patricia
authors.initials: P
authors.lastname: Hussack
authors.forename: Robert S
authors.initials: RS
authors.lastname: McKelvie
keywords: diagnosis; elderly; heart failure; long-term care; nursing home; transition