An electronic strategy to identify hospitalized heart failure patients

A common challenge in improving performance measures regarding heart failure (HF) is identifying patients early in the course of their hospitalization so that multidisciplinary education and clinical interventions can be implemented. We describe the accuracy of using an electronic pharmacy-based strategy to identify hospitalized patients likely to have a principal diagnosis of HF at discharge.

We evaluated 2 strategies. The first used the receipt of an intravenous loop diuretic as a single predictor; the second incorporated additional lab, pharmacy, and demographic information in a multivariable general estimating equation.

Receipt of an intravenous diuretic predicted a discharge diagnosis of heart failure with a sensitivity of 0.89 and a specificity of 0.87. Adding age, B-type natriuretic peptide level, previous hospitalizations, attending physician specialty, and receipt of spironolactone into the predictor improved the sensitivity to 0.91 and the specificity to 0.89.

The receipt of intravenous loop diuretics is a reasonable and easily implemented screening test to identify patients likely to have a principal diagnosis of heart failure at discharge. The accuracy is improved by incorporating other electronically available variables.