Heart failure labelled patients with missing ejection fraction in primary care : prognosis and determinants
Muñoz, Miguel-Angel (Universitat Autònoma de Barcelona. Departament de Medicina)
Mundet-Tudurí, Xavier (Universitat Autònoma de Barcelona)
Real, Jordi (Universitat Internacional de Catalunya. Epidemiologia i Salut Pública)
Del Val García, José Luis (Institut Català de la Salut)
Domingo, Mar (Institut Català de la Salut)
Vinyoles, Ernest (Universitat Autònoma de Barcelona. Departament de Medicina)
Calero, Esther (Institut Català de la Salut)
Checa Jiménez, Caterina (Institut Català de la Salut. Centre d'Atenció Primària Dreta de l'Eixample de Barcelona)
Soldevila-Bacardit, Nuria (Institut Català de la Salut)
Verdú Rotellar, Jose María (Universitat Autònoma de Barcelona. Departament de Medicina)

Fecha:	2017
Resumen:	It is common to find a high variability in the accuracy of heart failure (HF) diagnosis in electronic primary care medical records (EMR). Our aims were to ascertain (i) whether the prognosis of HF labelled patients whose ejection fraction (EF) was missing in their EMR differed from those that had it registered, and (ii) the causes contributing to the differences in the availability of EF in EMR. Retrospective cohort analyses based on clinical records of HF and attended at 52 primary healthcare centres of Barcelona (Spain). Information of 8376 HF patients aged > 40 years followed during five years was analyzed. EF was available only in 8. 5% of primary care medical records. Cumulate incidence for mortality and hospitalization from 1st January 2009 to 31th December 2012 was 37. 6%. The highest rate was found in patients with missing EF (HR 1. 84, 95% CI 1. 68 -1. 95) compared to those with preserved EF. Patients hospitalized the previous year and those requiring home healthcare (HR 1. 81, 95% Confidence Interval 1. 68-1. 95 and HR 1. 58, 95% CI 1. 46-1. 71, respectively) presented a higher risk of having an adverse outcome. Older patients, those more socio-economically disadvantaged, obese, requiring home healthcare, and taking loop diuretics were less likely to have an EF registered. EF is poorly recorded in primary care. HF patients with EF missing at medical records had the worst prognosis. They tended to be older, socio-economically disadvantaged, and more fragile.
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Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Primary care ; Heart failure ; Echocardiography ; Diagnosis
Publicado en:	BMC family practice, Vol. 18 (March 2017) , art. 38, ISSN 1471-2296

DOI: 10.1186/s12875-017-0612-6
PMID: 28302060

Published Version 7 p, 440.6 KB

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