Heterogeneity in diagnosing heart failure - real world data from electronic health records

Heart failure (HF) prevalence is increasing and is relatively well described. Less is known about using tests in diagnosing HF in clinical practice. The aim of this article was to describe the diagnostic practices among incident HF patients in Estonia. Electronic health records and healthcare provision claims from 1st January 2012 to 31st December 2019 for a random sample of 10% of the Estonian population ( N = 150 824) were used to retrieve data about newly diagnosed HF patients focusing on natriuretic peptide and echocardiographic testing. The incident HF was defined as the first occurrence of International Statistical Classification of Diseases and Related Health Problems 10th Revision codes I50.x or I11.0, with no occurrence of I50.x or I11.0 during the previous four years. The group differences were analysed using the Wilcoxon rank sum test for continuous variables. For categorical variables, the chi-square test and binary logistic regression, controlled for gender and age, were used. Within one year before and after the HF diagnosis, 31.0% of patients underwent echocardiography and natriuretic peptide testing, but 40.7% did not receive either investigation. Most diagnostic assessments were performed in three months before HF diagnosis with 41% of patients receiving at least one test. We observed that patients diagnosed with HF in emergency departments were most likely to undergo at least one HF test (81,3%). In clinical practice, HF may be diagnosed in the absence of sufficient diagnostic evidence. By highlighting key shortcomings in the routine clinical diagnosis of HF, this study underscores the potential to enhance patient care (e.g. creating HF pathways).