title: Diagnostic discrepancies in clinical practice: An autopsy study in patients with heart failure.
abstract: Autopsies are the gold standard for diagnostic accuracy; however, no recent study has analyzed autopsies in heart failure (HF).We reviewed 1241 autopsies (January 2000-May 2005) and selected 232 patients with HF. Clinical and autopsy diagnoses were analyzed and discrepancies categorized according to their importance regarding therapy and prognosis.Mean age was 63.3 ± 15.9 years; 154 (66.4%) patients were male. The causes of death at autopsy were end-stage HF (40.9%), acute myocardial infarction (17.2%), infection (15.9), and pulmonary embolism 36 (15.5). Diagnostic discrepancies occurred in 191 (82.3%) cases; in 56 (24.1%), discrepancies were related to major diagnoses with potential influence on survival or treatment; pulmonary embolism was the cause of death for 24 (42.9%) of these patients. In 35 (15.1%), discrepancies were related to a major diagnosis with equivocal influence on survival or treatment; in 100 (43.1%), discrepancies did not influence survival or treatment. In multivariate analysis, age (OR: 1.03, 95% CI: 1.008-1.052, P = 0.007) and presence of diabetes mellitus (OR: 0.359, 95% CI: 0.168-0.767, P = 0.008) influenced the occurrence discrepancies.Diagnostic discrepancies with a potential impact on prognosis are frequent in HF. These findings warrant reconsideration in diagnostic and therapeutic practices with HF patients.
authors.affiliation: Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP), Brazil.
authors.forename: Victor Sarli
authors.initials: VS
authors.lastname: Issa
authors.forename: Layara Fernanda Lipari
authors.initials: LFL
authors.lastname: Dinardi
authors.forename: Thiago Vicente
authors.initials: TV
authors.lastname: Pereira
authors.forename: Lyna Kyria Rodrigues
authors.initials: LKR
authors.lastname: de Almeida
authors.forename: Thaisa Silveira
authors.initials: TS
authors.lastname: Barbosa
authors.forename: Luiz Alberto
authors.initials: LA
authors.lastname: Benvenutti
authors.forename: Silvia Moreira
authors.initials: SM
authors.lastname: Ayub-Ferreira
authors.forename: Edimar Alcides
authors.initials: EA
authors.lastname: Bocchi
mesh_terms: D000368:Aged; D001344:Autopsy; D016757:Death, Sudden, Cardiac; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016277:Ventricular Function, Left