title: Probability of Accurate Heart Failure Diagnosis and the Implications for Hospital Readmissions.
abstract: Heart failure (HF) is a complex syndrome with inherent diagnostic challenges. We studied the scope of possibly inaccurately documented HF in a large health care system among patients assigned a primary diagnosis of HF at discharge. Through a retrospective record review and a classification schema developed from published guidelines, we assessed the probability of the documented HF diagnosis being accurate and determined factors associated with HF-related and non-HF-related hospital readmissions. An arbitration committee of 3 experts reviewed a subset of records to corroborate the results. We assigned a low probability of accurate diagnosis to 133 (19%) of the 712 patients. A subset of patients were also reviewed by an expert panel, which concluded that 13% to 35% of patients probably did not have HF (inter-rater agreement, kappa = 0.35). Low-probability HF was predictive of being readmitted more frequently for non-HF causes (p = 0.018), as well as documented arrhythmias (p = 0.023), and age >60 years (p = 0.006). Documented sleep apnea (p = 0.035), percutaneous coronary intervention (p = 0.006), non-white race (p = 0.047), and B-type natriuretic peptide >400 pg/ml (p = 0.007) were determined to be predictive of HF readmissions in this cohort. In conclusion, approximately 1 in 5 patients documented to have HF were found to have a low probability of actually having it. Moreover, the determination of low-probability HF was twice as likely to result in readmission for non-HF causes and, thus, should be considered a determinant for all-cause readmissions in this population.
authors.affiliation: Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas. Electronic address: sandra.carey@bswhealth.org.
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Carey
authors.affiliation: Soltero Cardiovascular Research Center, Baylor University Medical Center, Dallas, Texas.
authors.forename: Kyle
authors.initials: K
authors.lastname: Bass
authors.affiliation: Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Saracino
authors.affiliation: Soltero Cardiovascular Research Center, Baylor University Medical Center, Dallas, Texas.
authors.forename: Cara A
authors.initials: CA
authors.lastname: East
authors.affiliation: Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas.
authors.forename: Joost
authors.initials: J
authors.lastname: Felius
authors.affiliation: Jack and Jane Hamilton Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Grayburn
authors.affiliation: Jack and Jane Hamilton Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas.
authors.forename: Ravi C
authors.initials: RC
authors.lastname: Vallabhan
authors.affiliation: Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas.
authors.forename: Shelley A
authors.initials: SA
authors.lastname: Hall
mesh_terms: D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis*; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011336:Probability; D012189:Retrospective Studies