The Value of Admission Clinical Data for Diagnosing Heart Failure in Long-term Care.

backgroundHeart failure (HF) is common in long-term care (LTC). Diagnostic uncertainty is important barrier to optimal HF management, stemming from inadequate health information transfer upon LTC admission. We determine the utility of admission clinical information to confirm a HF diagnosis in new LTC residents.

methodsThis was a prospective cohort study. From February 2004 to November 2006, information about new residents from 41 LTC homes in Ontario, Canada, was collected from residents and caregivers, and all available health records. A prior HF diagnosis was confirmed by consensus review of available data by two independent experts. Multivariate modelling was utilized to determine the utility of the admission clinical assessment in confirming a prior HF diagnosis.

resultsA total of 449 residents were included for analysis, aged 84.3±6.5 years, and 21.6% had a prior HF diagnosis. The most useful clinical item for diagnosing HF was a "history of HF". The final model included "history of HF' (OR [odds ratio] 13.66, 95% CI 6.61-28.24), "fluid on the lungs" (OR 2.01, 95% CI 1.04-3.89), "orthopnea" (OR 1.76, 95% CI 0.93-3.33), "taking β-blocker" (OR 2.09, 95% CI 1.10-3.94), "taking loop diuretics" (OR 2.11, 95% CI 1.12-3.98), and "history of coronary artery disease" (OR 2.83, 95% CI 1.42-5.64).

conclusionElements of the clinical assessment for new LTC residents can help confirm a prior HF diagnosis. An admission history of HF is highly predictive.