Introduction
Medical diagnosis is the basis for
decision-making in clinical practice. It provides essential information
that can affect the quality of patient health care in acute
diseases.1 In fact, there is a strong relationship
between the accurate diagnosis and appropriate
treatment.2 Hospitalizing, Laboratory test type,
medication, treatment approach and length of stay(LOS) depends on the
admission diagnosis (ADX).3
ADX can be consider as a primary or presumptive
diagnosis of a patient’s condition or disorder at the admission time.
The discharge diagnosis (DDX) is the final diagnosis
given a patient before release from the hospital after all testing,
surgery and workup are complete. Agreement of ADx and
DDX is important in the evaluation of health care system
efficiency. Any discrepancy can change or continue the medical education
policies and the treatment approaches.3 Discrepancy of
ADX and DDX can occur in various disease
and lead to medical errors. The health care system can prevent or reduce
these errors by lessen the ADx and DDx mismatch rates. It can improve
the efficiency of health care system and decrease the additional
treatment cost.4,5
According to the World Health
Organization (WHO) report, chronic disease will be the main cause of
disability until 2020. Cardiovascular diseases (CVDs) are the most
common chronic disease which if not manage properly, it will be a
serious and costly problem’ in the health care system and
society.6 CVDs includes coronary artery disease, heart
failure, myocardial infarction, arrhythmia and cardiomyopathy and
etc.(table 1) The WHO estimates that if the current increasing trends of
CVDs continue; 25 percent of lives will be lost in the
world.7 The Iranian Ministry of Health and Medical
Education Official statistics in 2017 show that 39% of deaths in Iran
and 42% of deaths in Zanjan were due to CVDs.8 Recent
researches has shown that CVDs does not occur under a specific
condition, many conditions involved and the main causes of CVDs still
remain unclear. In addition, the symptoms of heart disease are similar
to each other which can makes it hard for physicians to make a decision
about the ADX. The ADX is very important
and vital in some conditions like Ischemic heart diseases which require
accurate diagnosis and quick
treatment.9
Achieving a high degree of agreement diagnostic in medical settings is
important. This reflects the physician’s professional competence and can
affect the patient-care quality. Misdiagnosis or disagreements between
ADX and DDX can lead to irreversible
consequences. Therefore, because of high incidence of CVDs in Zanjan and
the serious complications of the ADX and
DDX disagreement, this study aimed to determine the
discrepancy between the ADX and DDX of
CVDs.