Heart failure diagnosis in acute conditions has high agreement with inpatient diagnosis
Marie-France Seronde1, Said Laribi, Sean P Collins
1aUMR-S 942 Inserm bDepartment of Emergency Medicine cIntensive Care Unit dDepartment of Cardiology eDepartment of Anesthesiology and Intensive Care fParis Diderot University, Sorbonne Paris Cité gDHU FIRE, Paris Diderot University hAPHP, Saint Louis Lariboisière University Hospitals, Paris iDepartment of Cardiology, EA3920, University Hospital Jean Minjoz, Besancon, France jDepartment of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA.
Insights
Diagnosing acute heart failure (AHF) in the emergency department (ED) is highly accurate. Initial clinical and biomarker assessments show strong agreement with later diagnoses, supporting early treatment decisions.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Diagnostics
Background:
- Acute heart failure (AHF) presents frequently in emergency departments (ED) and critical care units.
- Distinguishing cardiac from noncardiac causes of dyspnea can be challenging with standard methods.
Purpose of the Study:
- To evaluate the agreement between initial physician diagnosis, hospital discharge diagnosis, and an expert adjudication committee for AHF.
- To assess the reliability of early AHF diagnosis in undifferentiated dyspnea cases.
Main Methods:
- Prospective enrollment of consecutive patients presenting with dyspnea between 2010-2011.
- Inclusion of patients admitted via ED (280) or CCU/ICU (112) for undifferentiated dyspnea.
Main Results:
- High agreement was observed between initial AHF diagnosis and hospital discharge (95.5%) or adjudicated (98%) diagnoses.
- Few discrepancies were noted between initial assessments and final diagnostic outcomes.
Conclusions:
- Initial AHF diagnosis using clinical signs and B-type natriuretic peptide testing demonstrates high accuracy and agreement with definitive diagnoses.
- Reliable early AHF diagnosis facilitates prompt patient management and inclusion in clinical trials.
Objectives:
Acute heart failure (AHF) is frequently encountered in the emergency department (ED) or in the cardiac care unit (CCU)/ICU. Discrimination between cardiac and noncardiac cause of dyspnea by clinical means and standard testing is sometimes inadequate. The aim of our study was to assess AHF diagnosis agreement as determined by: (a) the attending physician, (b) the hospital discharge diagnosis, and (c) an adjudication committee.
Patients And Methods:
Between 2010 and 2011, consecutive patients arriving for dyspnea in our hospital were prospectively included. A convenience sample of patients was enrolled in this analysis. Patients were admitted through the ED (280 patients) or through CCU/ICU (112 patients) for undifferentiated dyspnea.
Results:
Overall, few differences were observed between the initial diagnosis and the hospital discharge diagnosis or the adjudicated diagnosis. Among the 200 patients with an initial diagnosis of AHF, hospital discharge diagnosis confirmed AHF (alone or combined) in 191 (95.5%) patients and the adjudication committee confirmed AHF (alone or combined) in 196 (98%) patients.
Conclusion:
Our study showed considerable agreement between different AHF diagnostic standards. An initial AHF diagnosis on the basis of clinical signs and biological parameters utilizing B-type natriuretic peptide testing has high agreement and accuracy with the hospital discharge and adjudicated diagnosis of AHF. The present study also shows that the accuracy of the initial AHF diagnosis allows rapid inclusion in AHF trials. These results, if confirmed in a broader cohort of patients, suggest that the initial ED diagnosis is highly accurate and reliable to guide further inpatient management.
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