Introduction

Heart failure (HF) contributes to around one million hospitalizations annually in the USA people and represents one of the primary risk factors for significant postoperative complications, mortality, readmission, and prolonged postoperative hospital stays. To minimize the adverse effects of HF and other concurrent medical conditions on postoperative outcomes, preoperative evaluation clinics for anesthesia aid in devising perioperative care strategies and enhance cost-effectiveness by identifying and optimizing such health issues prior to surgery. As surgical caseloads and intricacy rise, preoperative assessments have increasingly transitioned from traditional in-person consultations to triage systems employing screening questionnaires and virtual platforms. This shift streamlines preoperative processes for patients deemed to be at low risk while allowing for more targeted assessments of complex or high-risk patients, potentially including those with heart failure, before surgery. The accurate diagnosis of Heart Failure (HF) is essential for effective management, particularly in preoperative settings. Due to the complex nature of HF, relying on a single inexpensive and reliable diagnostic test is not feasible, especially among patients with preserved ejection fraction. Clinicians typically diagnose HF based on a combination of factors, including patient history, physical examination, and various medical tests. However, diagnostic discrepancies can arise due to the diverse causes and clinical presentations of HF. Despite previous discussions on the limitations of clinical documentation accuracy in HF preoperative care, disagreements and uncertainties among physicians regarding HF diagnoses are not well explored. Understanding the characteristics of patients for whom physicians disagree on HF presence or absence could inform targeted improvements in Electronic Health Record (EHR)-based preoperative screening processes. This could involve additional consultations and evaluations for patients with potentially challenging HF diagnoses, while streamlining the review process for those with straightforward diagnoses and management plans.

Preoperative diagnosis

To comprehend the constraints associated with preoperative assessments in patients potentially having Heart Failure (HF) and to delineate the reasons behind physician disagreements regarding the diagnosis, we conducted an observational cohort study within our institution. The objectives of this investigation were twofold: (i) to characterize the level of agreement among multiple physicians specializing in HF care in their adjudicated preoperative HF diagnoses; and (ii) to discern the patient attributes associated with instances where physicians concurred or differed regarding the HF diagnosis. We posited that distinct perioperative factors would be linked with physician discordance regarding the preoperative HF diagnosis. Scientific literature plays a pivotal role in advancing understanding and guiding future research endeavors. A critical aspect of these publications is the clear and comprehensive presentation of the methodologies employed. Equally significant are efforts towards replicating and reproducing studies to ensure the credibility and applicability of research findings. However, there exists confusion, as different scientific disciplines often interchange the terms "replication" and "reproduction". To address this ambiguity, the National Science Foundation (NSF) of the United States of America has defined reproducibility as achieving identical results utilizing the same raw data, algorithms, procedures, analytical code, and conditions. In contrast, replication aims to address a similar question using a novel data collection approach, involving more complexity and departing from the methodologies of prior works. Transparency plays a pivotal role in both replicating and reproducing studies, encompassing the disclosure of Conflicts of Interest (COI) and funding sources, sharing raw data and software code, detailing search strategies and bias assessments, and adhering to standardized reporting protocols.

Meta research

The realm of cardiology represents a dynamic and swiftly evolving domain of scientific inquiry, continually yielding fresh perspectives and advancements in understanding and treating cardiovascular ailments. This constant influx of research necessitates thorough scrutiny to ascertain its credibility and applicability. A notable challenge in cardiology research lies in the disparities observed between Randomized Controlled Trials (RCTs) and other study methodologies, underscoring the importance of judicious interpretation and resolution of discrepancies. This becomes particularly critical in the sphere of heart failure, which stands as the second most prevalent cause of hospital admissions in the USA. The substantial economic impact associated with heart failure, accounting for a notable proportion of healthcare expenditures globally, underscores the urgency of addressing these disparities and establishing robust evidence to inform the formulation of safe and efficacious patient care protocols. To date, there is a scarcity of literature investigating meta-research practices specifically within the domain of heart failure. This study aims to fill this gap by conducting a comprehensive review and analysis of various transparency indices employed in a sizable body of heart failure meta-analyses using rigorous methodology. Our findings shed light on areas warranting improvement and potentially offer valuable insights to propel the field forward.