Comparison between clinical and necroscopic diagnoses in patients with heart failure

Abstract

Introduction: Necropsies are important to confirm diagnostic hypothesis made in vivo; however, few studies analyzed necroscopic findings in patients with heart failure. Purpose: To study clinical and necroscopic data of patients with heart failure focusing on the occurrence of diagnostic discrepancies. Methods: Necropsies and medical charts of patients over 18 years old deceased from January 2000 to July 2001 were reviewed. Inclusion criteria were: heart failure, cardiogenic shock and cardiomyopathy; exclusion criteria were: congenital cardiomyopathy, primary valve defect, pericardium diseases, post-operative shock. Discrepancies between clinical and necroscopic diagnosis were categorized in classes I to V in decreasing order of clinical importance. Results: On the necropsy data (99 cases), the main cause of death were cardiogenic shock in 39 cases (39.4%); septic shock in 22 (22.2%) and pulmonary embolism in 15 (15.2%). Were available the charts of 87 patients. Of these, 53 (60.9%) corresponded to men and 34 (39.1%) to women and the mean age was 62.8±15.4 years. The etiologies of the cardiomyopathy were ischemic in 39 (44.8%) patients, chagasic in 17 (19.5%), hypertensive in 16 (18.4) and idiopathic in 13 (14.9%). In the analysis of Goldman's criteria, we have found diagnostic discrepancies in 48 cases (55.2%): major discrepancies in 43 cases (49.4%), 24 (27.6%) class I and 19 (21.8%) class II; minor discrepancies in 5 (5.7%) and absolute agreement (class V) in 39 (44.8%). Major diagnostic discrepancies were found in 43 (49.4%) patients (classes I 27.6%, and II 21.8%). Minor diagnostic discrepancies were found in 5 (5.7%) patients (classes III – 2.3%, and IV 3.4%). In 39 patients (44.8%) no discrepancy was found. Conclusion: The high number of misdiagnoses in patients with heart failure, what can be related to the severity of this syndrome, supports the importance of necropsies for better comprehension of disease mechanisms. Moreover, the discrepancies between clinical and necroscopic diagnostics highlights the necessity of further studies in this field in order to evaluate the quality of the care and, finally, to subsidize a better structuring of diagnostic and therapeutic methods.