Key result
Secondary HF diagnosis linked to ~3-fold higher index admission mortality versus uncertain diagnosis.
Why the study?
Most studies on acute heart failure admissions and outcomes have focused only on HF coded as the primary diagnosis, underestimating the total hospital burden and health economic impact of HF.
Does the diagnostic coding position of acute heart failure (primary vs secondary) relate to mortality in hospitalized patients?
Observational (n=10,701)
Yes
Does the diagnostic coding position of acute heart failure (primary vs secondary) relate to mortality in hospitalized patients?
Hazard Ratio: 3.26
Absolute Event Rate: 16% vs 4%
p-value: p=< 0.001
Patients admitted with heart failure as a secondary diagnosis have significantly higher in-hospital mortality than those with HF as a primary diagnosis, highlighting a high-risk, under-recognized population.
Secondary HF coding identifies higher-risk inpatients for closer evaluation; leaves open whether position reflects acuity or documentation practices.
AIMS: Most studies on acute heart failure (HF) exploring the relationship between admissions to hospital for HF and subsequent outcomes have focused only on HF coded as the primary diagnosis, but many other patients have admissions complicated by HF requiring attention. Failure to quantify the total hospital burden of HF underestimates its health economic impact, leading to underprovision of resources for its care. METHODS AND RESULTS: The First Euro Heart Failure Survey (EHFS-1) screened consecutive deaths and discharges, regardless of cause, from medical wards in 115 hospitals from 24 European countries during 2000-2001, to identify patients with known or suspected HF. Information on presenting symptoms and signs were gathered. Of 10 701 patients enrolled, HF was reported as the primary reason for admission in 4234 (40%), a secondary reason for admission if it complicated or prolonged stay in 1772 (17%), and in 4695 (43%) patients it was uncertain whether HF was actively contributing to the admission. Mortality on the index admission was 301 (7%), 290 (16%), and 189 (4%), respectively, with hazard ratios of 1.73 (P < 0.001) and 3.26 (P < 0.001) compared with the 'uncertain' group. In the 12 weeks following discharge, 287 (7%) patients with a primary, 117 (8%) with a secondary, and 238 (5%) with an incidental or uncertain diagnosis of HF died. CONCLUSION: Patients admitted to hospital with HF as a secondary rather than a primary diagnosis have a high mortality. More attention should be focused on patients with a secondary diagnosis of HF in terms of both care and research.
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Shoaib et al. (2016) conducted an observational in Acute heart failure (n=10,701). Heart failure as a secondary diagnosis vs. Heart failure as an uncertain diagnosis was evaluated on Mortality on the index admission (HR 3.26, p=< 0.001). Patients admitted with heart failure as a secondary diagnosis had significantly higher index admission mortality compared to those with an uncertain diagnosis (16% vs 4%; HR 3.26, P<0.001).
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