Key result
Inpatient HF diagnosis is linked to ~62% higher risk of CV death or hospitalization versus outpatient.
Why the study?
Limited access to echocardiography may lead to delayed heart failure diagnosis during hospitalization, but outcomes comparing inpatient versus outpatient diagnosis across ejection fraction strata were unclear.
Does inpatient diagnosis of heart failure compared to outpatient diagnosis worsen the risk of cardiovascular death or heart failure hospitalization?
Cohort (n=5,223)
Does inpatient diagnosis of heart failure compared to outpatient diagnosis worsen the risk of cardiovascular death or heart failure hospitalization?
Patients diagnosed with heart failure during a hospitalization have a significantly higher risk of cardiovascular death or heart failure hospitalization within 12 months compared to those diagnosed in an outpatient setting.
Answers are grounded in this paper and cite their sources.
Inpatient HF diagnosis identifies higher short-term risk; hypothesis-generating for earlier detection strategies.
BACKGROUND: Early heart failure (HF) diagnosis is crucial to ensure that optimal guideline-directed medical therapy (GDMT) is administered to reduce morbidity and mortality. Limited access to echocardiography could lead to a later diagnosis for patients, for example, during an HF hospitalisation (hHF). This study aimed to compare the incidence and outcomes of inpatient versus outpatient diagnosis of HF. METHODS: Electronic health records were linked to echocardiography data between 2015 and 2021 from patients in Tayside, Scotland (population~450 000). Incident HF diagnosis was classified into inpatient or outpatient and stratified by ejection fraction (EF). A non-HF comparator group with normal left ventricular function was also defined. The primary outcome was time to cardiovascular death or hHF within 12 months of diagnosis. RESULTS: In total, 5223 individuals were identified, 4231 with HF (1115 heart failure with reduced ejection fraction (HFrEF), 666 heart failure with mildly reduced ejection fraction, 1402 heart failure with preserved ejection fraction and 1048 HF with unknown EF) and 992 with non-HF comparators. Of the 4231 HF patients, 2169 (51.3%) were diagnosed as inpatients. The primary outcome was observed in 1193 individuals with HF (28.1%) and 32 (3.2%) non-HF comparators and was significantly more likely to occur in individuals diagnosed as inpatients than outpatients (809 vs 384 events; adjusted HR: 1.62 (1.39-1.89), p<0.001), and this was consistent regardless of EF. For HFrEF patients first diagnosed as inpatients, those discharged on ≥2 GDMT had a reduced incidence of the primary outcome compared with those discharged on <2 GDMT (303 vs 175 events; adjusted HR: 0.72 (0.55-0.94), p=0.016). CONCLUSIONS: Individuals whose first presentation was a HF hospitalisation had a significantly worse outcome than those who were diagnosed in the community. Among hospitalised individuals, higher use of GDMT was associated with improved outcomes. Our results highlight the importance of improving diagnostic pathways to allow for earlier identification and treatment of HF.
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Wang et al. (2025) conducted a cohort in Heart failure (n=5,223). Inpatient diagnosis vs. Outpatient diagnosis was evaluated on Time to cardiovascular death or heart failure hospitalisation within 12 months of diagnosis (adjusted HR 1.62, 95% CI 1.39-1.89, p=<0.001). Inpatient diagnosis of heart failure was associated with a higher risk of cardiovascular death or hospitalization compared to outpatient diagnosis.
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