June 10, 2008
View Full PaperAccuracy of a heart failure diagnosis in administrative registers
Key Result
A registered heart failure diagnosis in the Danish National Registers had a specificity of 99% but only a sensitivity of 29%, indicating underreporting.
Structured PICO
Does a heart failure diagnosis in administrative registers accurately reflect true clinical heart failure in hospitalized patients?
P
Population
Consecutive patients admitted to all departments in one hospital
I
Intervention
Heart failure diagnosis reported to the Danish National Patient Registers during routine clinical work
C
Comparator
Independent clinical evaluation by a study team including echocardiogram and symptom assessment (ESC guidelines)
O
Outcome
Accuracy (sensitivity, specificity, positive predictive value, negative predictive value) of a heart failure diagnosis
Heart failure diagnoses in administrative registers are highly specific but have low sensitivity, indicating significant underreporting in routine clinical data.
Main Result
Absolute Event Rate: 0% vs 0%
Abstract
Abstract Background: The incidence of heart failure is frequently reported using hospital discharge diagnoses. The specificity of a diagnosis has been shown to be high but the sensitivity of a reported diagnosis is unknown. Purpose: To study the accuracy of a heart failure diagnosis reported to the Danish National Patient Registers during routine clinical work. Methods: The patient population consisted of 3644 consecutive patients admitted to all departments in one hospital. Diagnoses reported to the National Patient Register were recorded. A study team evaluated each patient independently of routine care, performed an echocardiogram and evaluated whether clinical symptoms of heart failure were present. Heart failure was defined in accordance with current ESC guidelines as symptoms of heart failure and evidence of cardiac dysfunction. Results: A registered diagnosis of heart failure ( n =126) carried a specificity of 99% and a sensitivity of 29% for all patients. The positive predictive value was 81%, the negative predictive value 90%. Conclusion: The diagnosis of Heart Failure in the Danish National Registers is underreported, but very specific.