Missed Opportunities in the Diagnosis of Heart Failure: Evaluation of Pathways to Determine Sources of Delay to Specialist Evaluation
Open accessAbstract
Missed opportunities are incidents where different actions by those involved could have resulted in more desirable events. Heart failure is a complex clinical syndrome presenting as symptoms and signs common to other diagnoses, in patients frequently with multiple co-morbidities. Heart failure itself is not a diagnosis, but is the common clinical presentation of a variety of cardiac conditions. Correct diagnosis involves amalgamation of the clinical presentation, the results of general and specific investigations, and the clinician's ability to synthesize the overall picture. It is not surprising therefore that misdiagnosis can occur at any level of the heart failure journey and can occur because of patient, clinician, and health economy related factors. Delayed diagnosis leads to excess morbidity and mortality in these patients. In this review, we define the pathways for diagnosis of heart failure and then highlight missed opportunities related to delay and misdiagnosis. In addition, we consider how the earlier opportunity may impact patients, clinicians and health services.
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Mild symptoms in older adults often go untreated, as they often assume these are just a normal part of aging, thereby missing out on potential diagnoses.
“The mild symptoms in older adults often go untreated, as they often assume these are just a normal part of aging, thereby missing out on potential diagnoses [54].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [54]
The Patient-Related Diagnostic Opportunities section says older people may attribute heart-failure symptoms to aging and fail to recognize a problem, delaying medical attention and diagnosis. The citing sentence broadens this heart-failure-specific discussion to mild symptoms and potential diagnoses generally, and says this often happens where the source says it may happen. (LLM, conf=0.84)
Experimental — accuracy not yet measuredWhen diagnosing older patients, symptoms such as heart failure may only be attributed to being old rather than other possible reasons.
“when diagnosing older patients, symptoms such as heart failure may only be attributed to being old rather than other possible reasons [54].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [54]
In heart failure, tests like B-type natriuretic peptide (BNP) and echocardiograms are less accessible in rural or underserved healthcare settings, leading to delayed diagnoses and treatments.
“For example, in heart failure, tests like B-type natriuretic peptide (BNP) and echocardiograms are less accessible in rural or underserved healthcare settings, leading to delayed diagnoses and treatments [54].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [54]
This results in delays in addressing critical underlying issues and diminishes the quality of care.
“This results in delays in addressing critical underlying issues and diminishes the quality of care [54].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [54]
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References 8 · Cited by 37
Research works printed but not linked: 8
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- [7]Kwok CS, Duckett S, Satchithananda D, Potluri R, Morgan-Smith D, Bellenger N, Gunning M, Mallen C. The patient, clinician and healthcare perspective in evaluating care pathways for stable chest pain. Crit Path Cardiol. 2021. PMID: 33958520. 33958520
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- Authors
- Kwok, C. S., Burke, H., McDermott, S., Welsh, V., Barker, D., Patwala, A., Duckett, S., Satchithananda, D., & Mallen, C. D.
- Affiliations
- Royal Stoke University Hospital (GB)
- Keele University (GB)
- Corresponding author
- Kwok, Chun Shing
- ORCID
- Venue
- Current Heart Failure Reports
- Published
- 2022-06-06
- Volume
- 19
- Issue
- 4
- Pages
- 247-253
- ISSN
- 1546-9530 (ISSN-L)
- 1546-9549
- PMC
- PMC9169019
- OpenAlex
- W4281729321
- Cited by
- 37
- References
- 8
- Citations by year
- 2026: 17 · 2025: 5 · 2024: 11 · 2023: 2 · 2022: 2
- FWCI
- 3.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Current Heart Failure Reports (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Keele Research Repository (Keele University) (submittedVersion)
- Funders
- National Institute for Health and Care Research (CL-2017-10-001)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Health Sciences › Health Professions › Health Information Management › Artificial Intelligence in Healthcare
- Keywords
- heart failure, missed opportunities, delayed diagnosis, misdiagnosis, specialist referral, diagnostic pathway, comorbidities, health care utilization, morbidity and mortality
- MeSH terms
- Heart Failure, Humans, Retrospective Studies
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