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Congestive heart failure incidence and prognosis: case identification using central adjudication versus hospital

Gina D Schellenbaum1, Susan R Heckbert, Nicholas L Smith

  • 1Department of Epidemiology, University of Washington, Seattle, WA 98101, and Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN, USA. ginas@u.washington.edu

Annals of Epidemiology
|June 21, 2005
PubMed

Insights

Hospital discharge diagnoses may overestimate congestive heart failure (CHF) incidence in older adults. Mortality rates following CHF onset appear similar across diagnostic methods, but higher if both are used.

Area of Science:

  • Cardiovascular Medicine
  • Epidemiology
  • Geriatrics

Background:

  • Accurate estimation of congestive heart failure (CHF) incidence and prognosis is crucial for public health and clinical practice.
  • Hospital discharge diagnoses are commonly used for epidemiological studies but may lack diagnostic precision.
  • Central adjudication by expert committees offers a more rigorous method for confirming medical events.

Purpose of the Study:

  • To compare the incidence and prognosis of hospitalized congestive heart failure (CHF) using hospital discharge diagnoses versus central adjudication.
  • To evaluate the impact of different diagnostic methods on mortality estimates in elderly CHF patients.

Main Methods:

  • Utilized the Cardiovascular Health Study (CHS) cohort of 5888 elderly adults.
  • CHF events were confirmed through physician committee adjudication, including clinical signs, symptoms, tests, and therapy.
  • Hospitalized CHF cases (n=1209) were identified using ICD-9 codes for discharge diagnoses or central adjudication.

Main Results:

  • Incidence rates for hospitalized CHF were higher with discharge diagnoses (24.6/1000 person-years) compared to central adjudication (17.1/1000 person-years).
  • Mortality rates were lower for patients identified by only one method (discharge diagnosis HR=0.77; adjudication HR=0.72) versus both.
  • The findings suggest potential overestimation of CHF incidence using discharge diagnoses alone.

Conclusions:

  • Studies relying solely on hospital discharge diagnoses may overestimate incident hospitalized congestive heart failure (CHF) in the elderly population.
  • Mortality following CHF onset may be comparable whether diagnosed by discharge diagnosis or central adjudication.
  • Combining both diagnostic methods may lead to higher observed mortality rates.
Abstract

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