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.