title: Is the diagnostic coding position of acute heart failure related to mortality? A report from the Euro Heart Failure Survey-1.
abstract: Most studies on acute heart failure (HF) exploring the relationship between admissions to hospital for HF and subsequent outcomes have focused only on HF coded as the primary diagnosis, but many other patients have admissions complicated by HF requiring attention. Failure to quantify the total hospital burden of HF underestimates its health economic impact, leading to underprovision of resources for its care.
  
  
  
  The First Euro Heart Failure Survey (EHFS-1) screened consecutive deaths and discharges, regardless of cause, from medical wards in 115 hospitals from 24 European countries during 2000-2001, to identify patients with known or suspected HF. Information on presenting symptoms and signs were gathered. Of 10 701 patients enrolled, HF was reported as the primary reason for admission in 4234 (40%), a secondary reason for admission if it complicated or prolonged stay in 1772 (17%), and in 4695 (43%) patients it was uncertain whether HF was actively contributing to the admission. Mortality on the index admission was 301 (7%), 290 (16%), and 189 (4%), respectively, with hazard ratios of 1.73 (P < 0.001) and 3.26 (P < 0.001) compared with the 'uncertain' group. In the 12 weeks following discharge, 287 (7%) patients with a primary, 117 (8%) with a secondary, and 238 (5%) with an incidental or uncertain diagnosis of HF died.
  
  
  
  Patients admitted to hospital with HF as a secondary rather than a primary diagnosis have a high mortality. More attention should be focused on patients with a secondary diagnosis of HF in terms of both care and research.
authors.affiliation: Cardiology Department, University of Hull, Castle Hill Hospital, Hull, UK.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Shoaib
authors.affiliation: Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Farag
authors.affiliation: Cardiology Department, University of Hull, Castle Hill Hospital, Hull, UK.
authors.forename: Mansoor
authors.initials: M
authors.lastname: Nasir
authors.affiliation: Cardiology Department, University of Hull, Castle Hill Hospital, Hull, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: John
authors.affiliation: Cardiology Department, University of Hull, Castle Hill Hospital, Hull, UK.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Cardiology Department, University of Hull, Castle Hill Hospital, Hull, UK.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Pellicori
authors.affiliation: Cardiology Department, University of Hull, Castle Hill Hospital, Hull, UK.
authors.forename: Renjith
authors.initials: R
authors.lastname: Antony
authors.affiliation: Cardiology Department, University of Hull, Castle Hill Hospital, Hull, UK.
authors.forename: Rashida
authors.initials: R
authors.lastname: Perveen
authors.affiliation: Cardiology Department, University of Hull, Castle Hill Hospital, Hull, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Rigby
authors.affiliation: Cardiology Department, University of Hull, Castle Hill Hospital, Hull, UK.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Goode
authors.affiliation: Cardiology Department, University of Hull, Castle Hill Hospital, Hull, UK.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Yassin
authors.affiliation: Cardiology Department, University of Hull, Castle Hill Hospital, Hull, UK.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
authors.affiliation: Cardiology Department, University of Hull, Castle Hill Hospital, Hull, UK.|National Heart & Lung institute, Imperial College London, UK.
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D059019:Clinical Coding; D005060:Europe / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016016:Proportional Hazards Models; D011795:Surveys and Questionnaires
keywords: Acute heart failure; Diagnostic position; EHFS-1; Prognosis