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Validity of heart failure diagnoses made in 2000-2012 in western Sweden
Maria Schaufelberger1, Sofia Ekestubbe1, Simon Hultgren1
1Emergency and Cardiovascular Medicine Section, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
Insights
This study found a high overall validity of heart failure (HF) diagnoses in Sweden. Echocardiography was key for confirming definite HF diagnoses, with its absence often leading to probable classifications.
Area of Science:
- Cardiology
- Public Health
- Medical Informatics
Background:
- The Swedish national inpatient register mandates reporting of all hospital discharge diagnoses.
- Heart failure (HF) diagnosis requires validation against established guidelines.
- Hospitalized patients in Sweden between 2000-2012 form the study cohort.
Purpose of the Study:
- To validate heart failure (HF) diagnoses against European Society of Cardiology (ESC) guidelines.
- To assess the accuracy of HF diagnoses recorded in the Swedish national inpatient register.
- To evaluate the role of echocardiography in confirming HF diagnoses.
Main Methods:
- Randomly selected 1100 records of patients diagnosed with HF.
- Validated diagnoses using ESC guidelines from 1995, 2001, 2005, and 2008.
- Classified cases into definite, probable, and miscoded groups based on validation.
Main Results:
- Overall HF diagnosis validity was high: 62.3% definite, 32.1% probable, 5.6% miscoded.
- Echocardiography was performed in 96.7% of definite HF cases.
- Lack of echocardiography was the primary reason for probable HF classification (63.8% of probable cases).
Conclusions:
- The overall validity of heart failure diagnoses at Sahlgrenska University Hospital is high.
- This suggests high diagnostic accuracy within the Swedish national patient register.
- The findings support the continued use of the register for epidemiological research.
Aims:
The aim of this study is to validate a diagnosis of heart failure (HF) according to the European Society of Cardiology (ESC) guidelines among patients hospitalized at Sahlgrenska University Hospital, Gothenburg, Sweden, between 2000 and 2012.
Methods And Results:
In Sweden, it is mandatory to report all hospital discharge diagnoses to the Swedish national inpatient register. In total, 27 517 patients were diagnosed with HF at the Sahlgrenska University hospital between 2000 and 2012. Altogether, 1100 records with a primary (n = 550) or contributory (n = 550) diagnosis of HF were randomly selected. The diagnosis was validated according to the ESC guidelines from 1995, 2001, 2005, and 2008, and cases were divided into three groups: definite, probable, and miscoded. In total, 965 cases were validated, while 135 records were excluded for various reasons. Of the 965 records, the diagnosis was validated as definite in 601 (62.3%) and as probable in 310 (32.1%); only 54 (5.6%) of cases had been miscoded. Echocardiography, as an objective evidence of cardiac dysfunction, had been performed in 581 (96.7%) of the definite, 106 (34.2%) of the probable, and 31 (57.4%) of the miscoded cases. Among the probable cases, the main reason they had not been classified as a definitive diagnosis of HF was lack of examination by echocardiography (63.8%).
Conclusions:
The overall validity of HF diagnosis at Sahlgrenska University Hospital is high. This may reflect a high diagnostic validity at the time of diagnosis in the national Swedish patient register, supporting the continued use of this register in epidemiological research.
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