The diagnosis of COPD requires confirmation by spirometry. Likewise, the diagnosis of CHF requires the use of a 2-D echo. However in clinical practice there appears to be a discrepancy with which the frequencies of these confirmatory tests are being utilized. We compared the frequency with which spirometry is being used in confirming the diagnosis of COPD versus the frequency of 2-D echo in the diagnosis of CHF.
We retrospectively reviewed a six-month period of charts of patients with a discharge diagnosis of COPD and CHF, either primary or secondary, as defined by an ICD-9-CM code of 496, 491.21 and 428-428.9 respectively. We then searched the PFT and echocardiography lab databases to check if the patient had a spirometry or a 2-D echo performed. These two groups were also compared with each other looking for patients with both diagnoses. The chi-square test was used to test the differences between the two groups. The study was part of quality assurance protocol as such was not reviewed by the institutional review board.
Out of the 553 individuals diagnosed with COPD, 169 patients (30%) had PFT’s performed within the past 7 years. In comparison, out of the 789 patients diagnosed with CHF, 619 patients (78%) had a 2-D echo performed within the past 7 years, (p<0.0001). There were a total of 219 patients with both diagnoses of COPD and CHF. One hundred and five patients (48%) had a 2-D echo only, 4 patients (2%) had spirometry only, 74 patients (34%) had both tests performed, and 36 patients (16%) had neither test performed.
Patients diagnosed with COPD were statistically less likely to have a confirmatory test performed than were patients diagnosed with CHF.
There appears to be a disconnect between the role of spirometry for confirming pulmonary diseases and that of echocardiography in CHF. To improve diagnosis and treatment of patients with COPD, effort must be made to close this gap.
M. Damarla, None.