Physician accuracy for diagnosing heart failure in unselected patients hospitalised with dyspnoea

Abstract

ABSTRACT Aim: To examine variables associated with heart failure (HF) and determine accuracy of Emergency Department (ED) physicians to diagnose HF in a Norwegian teaching hospital without point-of-care natriuretic peptide testing. Methods and results: We included 150 consecutive patients hospitalised for dyspnoea and collected the results of clinical examination and the probability of HF (0-100%) from the ED physicians. HF was adjudicated according to guidelines by two independent senior physicians. Of 150 patients, 68 patients (45%) were diagnosed with HF as the primary cause of the hospitalisation. HF patients were older (75.1 vs. 68.0 y, p<0.001) and more likely to be male (57% vs. 37%, p=0.01). There was no difference in New York Heart Association functional class or the duration of symptoms prior to hospitalization between HF patients and patients with non-HF dyspnoea. Several clinical variables previously reported to be predictive of HF were associated with HF by crude analysis in our patients, but only history of HF (HR 11.14 [OR 2.73-45.47], p<0.001), history of hypertension (HR 3.22 [OR 1.12-9.22], p=0.03), and atrial fibrillation (HR 3.22 [OR 1.21-10.58], p=0.02) were independently associated with HF in multivariate analysis. The area under the curve for ED physician diagnosis of HF was 0.85 (95% CI 0.79-0.91, p<0.001 vs. chance). Conclusion: The accuracy of the ED physicians for diagnosing HF was sub-optimal in this cohort of mainly elderly subjects hospitalised for dyspnoea. Physician should be aware of the increased likelihood of HF in dyspneic patients with atrial fibrillation, history of hypertension, or history of HF