Heart failure patients without echocardiography are more commonly diagnosed in hospital care and are associated with higher mortality compared to primary care

Abstract

Objective

This Swedish study aimed to assess the prevalence, associated clinical factors, and mortality rates of heart failure patients diagnosed without echocardiograms in both hospital and primary care settings.

Design

We conducted a retrospective population-based study using data from the Region Halland healthcare database in Sweden covering 330,000 residents.

Subjects

From 2013–2019, 3,903 patients received an incidental heart failure diagnosis without an echocardiogram and they were followed for one year.

Main outcome measures

Using logistic and Cox regression analyses, we evaluated the prevalence, clinical characteristics, and all-cause mortality at intervals of 30, 100, and 365 days post-diagnosis.

Results

In this Swedish cohort, the one-year all-cause mortality rate was markedly higher for patients diagnosed in hospitals (42%) compared to those in primary care (20%, p < 0.001). Patients diagnosed in primary care were older and had fewer comorbidities and lower NT-proBNP levels. Hospital-diagnosed patients faced a significantly higher mortality rate in the initial 30 days but saw similar rates to primary care patients thereafter.

Conclusion

In a Swedish region, heart failure diagnoses without echocardiograms were more common in hospitals, and these patients initially faced worse prognoses. After the first month, however, the prognosis of hospital-diagnosed patients mirrored that of those diagnosed in primary care. These findings emphasize the need for improved diagnostic and treatment approaches in both care settings to enhance outcomes.

KEY POINTS

• In a Swedish study, 58% of heart failure patients diagnosed without an echocardiogram were identified in a hospital setting. Patients diagnosed in primary care were generally older with fewer comorbidities and lower NT-proBNP levels. The first-year post-diagnosis mortality rate was higher for patients diagnosed in hospitals (42%) compared to those diagnosed in primary care (20%).

Despite a higher initial mortality for hospital-diagnosed patients, the rates became comparable with primary care diagnoses after the first month.

Keywords:

• Heart failure
• diagnostics
• one-year mortality
• primary care

Disclosure statement

No potential conflict of interest was reported by the authors.