Misdiagnosis of heart failure: A systematic review of the literature

Abstract

Background
Heart failure (HF) is a chronic disease associated with a significant burden to patients, families and health services. The diagnosis of HF can be easily missed due to similar symptoms with other conditions especially respiratory diseases.

Methods
We conducted a systematic review to determine the rates of HF and cardiomyopathy misdiagnosis and explored the potential causes. The included studies were narratively synthesized.

Results
10 studies were identified, including a total of 223,859 patients. There was a lack of definition of HF misdiagnosis in the studies and inconsistent diagnostic criteria were used. The rates of HF misdiagnosis ranged from 16.1% in hospital setting to 68.5% when general practitioner referred patients to specialist setting. The most common cause for misdiagnosis was chronic obstructive pulmonary disease (COPD). One study using a COPD cohort showed that HF was unrecognized in 19.6% of patients and 8% had misdiagnosis of HF as COPD. Another study suggests that anemia and chronic kidney disease is associated with an increase in odds of unrecognized left ventricular systolic dysfunction. Other comorbidities such as obesity, old age, atrial fibrillation and ischemic heart disease are prevalent in patients with misdiagnosis of HF.

Conclusion
Misdiagnosis of HF is an unfortunate part of everyday clinical practice which occurs with variable rate depending on the population studied. HF is frequently misdiagnosed as COPD. More research is needed to better understand the missed opportunities to correctly diagnose HF so that harm to patients can be avoided and effective treatments can be implemented.