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Is the diagnostic coding position of acute heart failure related to mortality? A report from the Euro Heart Failure Survey-1

Shoaib, Ahmad; Farag, Mohamed; Nasir, Mansoor; John, Joseph; Gupta, Sanjay; Pellicori, Pierpaolo; Antony, Renjith; Perveen, Rashida; Rigby, Alan; Goode, Kevin M.; Yassin, Ashraf; Clark, Andrew L.; Cleland, John G.F.


Ahmad Shoaib

Mohamed Farag

Mansoor Nasir

Joseph John

Sanjay Gupta

Pierpaolo Pellicori

Renjith Antony

Rashida Perveen

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Dr Kevin Goode
Research Systems Project Manager / Business Analyst

Ashraf Yassin

Andrew L. Clark

John G.F. Cleland


© 2016 The Authors. European Journal of Heart Failure. Aims Most studies on acute heart failure (HF) exploring the relationship between admissions to hospital for HF and subsequent outcomes have focused only on HF coded as the primary diagnosis, but many other patients have admissions complicated by HF requiring attention. Failure to quantify the total hospital burden of HF underestimates its health economic impact, leading to underprovision of resources for its care. Methods and results The First Euro Heart Failure Survey (EHFS-1) screened consecutive deaths and discharges, regardless of cause, from medical wards in 115 hospitals from 24 European countries during 2000-2001, to identify patients with known or suspected HF. Information on presenting symptoms and signs were gathered. Of 10 701 patients enrolled, HF was reported as the primary reason for admission in 4234 (40%), a secondary reason for admission if it complicated or prolonged stay in 1772 (17%), and in 4695 (43%) patients it was uncertain whether HF was actively contributing to the admission. Mortality on the index admission was 301 (7%), 290 (16%), and 189 (4%), respectively, with hazard ratios of 1.73 (P < 0.001) and 3.26 (P < 0.001) compared with the 'uncertain' group. In the 12 weeks following discharge, 287 (7%) patients with a primary, 117 (8%) with a secondary, and 238 (5%) with an incidental or uncertain diagnosis of HF died. Conclusion Patients admitted to hospital with HF as a secondary rather than a primary diagnosis have a high mortality. More attention should be focused on patients with a secondary diagnosis of HF in terms of both care and research.


Shoaib, A., Farag, M., Nasir, M., John, J., Gupta, S., Pellicori, P., Antony, R., Perveen, R., Rigby, A., Goode, K. M., Yassin, A., Clark, A. L., & Cleland, J. G. (2016). Is the diagnostic coding position of acute heart failure related to mortality? A report from the Euro Heart Failure Survey-1. European journal of heart failure, 18(5), 556-563.

Journal Article Type Article
Acceptance Date Jan 26, 2016
Online Publication Date Mar 16, 2016
Publication Date May 1, 2016
Deposit Date Dec 14, 2018
Journal European Journal of Heart Failure
Print ISSN 1388-9842
Electronic ISSN 1879-0844
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 18
Issue 5
Pages 556-563
Keywords Acute heart failure; EHFS-1; Diagnostic position; Prognosis
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