Related Experiment Videos

Chronic heart failure in the community: missed diagnosis and missed opportunities

K O Akosah1, K Moncher, A Schaper

  • 1Gundersen Lutheran Medical Center, 1836 South Ave., La Crosse, WI 54601, USA.

Journal of Cardiac Failure
|September 19, 2001
PubMed

Insights

Many patients admitted for shortness of breath with low ejection fraction have undiagnosed congestive heart failure (CHF). This missed diagnosis leads to high readmission rates and significant mortality, highlighting a critical gap in patient care.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Pulmonology

Background:

  • Congestive heart failure (CHF) poses a significant burden due to its prevalence, cost, and impact on morbidity and mortality.
  • Accurate incidence rates of CHF are challenging to ascertain due to reliance on discharge diagnoses and death certificates.
  • Clinical judgment plays a crucial role in diagnosing CHF, yet diagnostic errors can occur.

Purpose of the Study:

  • To determine the incidence of undiagnosed congestive heart failure (CHF) in hospitalized patients presenting with shortness of breath and low left ventricular ejection fraction (LVEF).
  • To identify factors contributing to missed CHF diagnoses in this patient population.
  • To assess the clinical outcomes, including readmission rates and mortality, associated with missed CHF diagnoses.

Main Methods:

  • Retrospective review of 225 randomly selected patients admitted with shortness of breath and discharged without a CHF diagnosis (Group 1).
  • Comparison of Group 1 with a control group (Group 2) of patients admitted with a confirmed CHF diagnosis, matched for age and LVEF.
  • Diagnosis of CHF in Group 1 was based on the Framingham criteria.

Main Results:

  • 51% of patients in Group 1 with low LVEF (< or =40%) met criteria for missed congestive heart failure (CHF).
  • The readmission rate for patients with missed CHF was high at 42%, with 18% mortality at 12 months.
  • While cardiomegaly was similar, third heart sound and heart rate > 120 beats/min were more frequent in the missed CHF group, whereas signs of fluid overload were more common in the diagnosed CHF group.

Conclusions:

  • A substantial proportion of patients admitted with shortness of breath and low LVEF are not diagnosed with congestive heart failure (CHF).
  • Physicians may overlook CHF diagnoses in patients without overt fluid overload, even with indicators like third heart sound and resting tachycardia.
  • Missed CHF diagnoses are linked to high readmission rates and mortality comparable to newly diagnosed CHF patients.
Abstract

Related Concept Videos

Heart Failure IV: Classification and Diagnostic Evaluation01:30

Heart Failure IV: Classification and Diagnostic Evaluation

Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...
Heart Failure I: Introduction01:27

Heart Failure I: Introduction

Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
Heart Failure VII: Nursing Interventions01:30

Heart Failure VII: Nursing Interventions

The first step in nursing management of a patient with heart failure involves thoroughly assessing the patient's medical history.Subjective Data: Obtain the patient's medical history of coronary artery disease, hypertension, myocardial infarction, and symptoms like dyspnea, orthopnea, and paroxysmal nocturnal dyspnea.Objective Data: Conduct a physical examination to identify findings such as jugular vein distention, pulmonary crackles, tachycardia, murmurs, peripheral edema, and vital signs,...
Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
Heart Failure III: Clinical Manifestations01:26

Heart Failure III: Clinical Manifestations

Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...