Heart failure diagnosis likely missed in primary care setting for these groups, study finds

Many new heart failure diagnoses occur in the emergency department or during hospitalization, particularly among women, Black adults, and those with lower net worth, according to research published July 27 in Heart Failure.

"This national study raises concerns that many heart failure diagnoses may be missed in a primary care setting," said Rebecca Tisdale, MD, study author and health services research and development fellow at the U.S. Department of Veterans Affairs. 

Researchers analyzed nearly 1 million insurance claims made across 2003-19 from a national database to evaluate at which type of care settings patients were receiving new heart failure diagnoses.

Overall, 38 percent of first-time heart failure diagnoses were made in acute care settings such as the emergency department, despite many of these patients displaying potential symptoms of the condition during primary care visits in the six months prior, findings showed. Of this group, 46 percent of patients had potential symptoms such as edema, cough and chest pain during their earlier primary care visits. 

Additionally, women were 1.1 times more likely than men to receive a heart failure diagnosis in an acute care setting. The same was true for Black patients, who were 1.18 times more likely than white patients to be diagnosed in such settings. When analyzed by net worth, patients with a value under $25,000 had 39 percent higher odds of being diagnosed with HF compared to people with a networth of more than $500,000, findings showed. 

"These results raise concerns that many HF diagnoses are missed in the outpatient setting," researchers said. "Earlier diagnosis could allow for timelier high-value interventions, addressing disparities and reducing the progression of HF." 

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