Clinical complexity

 'Purported' HFpEF Case 1

https://mahithguduri63.blogspot.com/2021/09/hfpef-with-ckd-with-htn.html?m=1

Individual problems:Dyspnea,malaise,poor appetite and sleep quality,erratic bowel habits.

Community level/family level problems:No medical practitioner bothered to know the exact cause for her renal failure,reasons for refusal of blood transfusion is not identified and not addressed,patient was not asked to follow up with specialist care,reasons for patient left to fend for herself until very sick are unknown,likely contributed by both family and poor quality of care at the community level.

Medical system problems:Low quality of data documentation,generic one size fits all therapy for any patient with ckd,cause of ckd unknown,patient presented with breathlessness as her chief concern and worsened further in hospital with same problem(no audit for this),cause of anemia poorly evaluated,other causes of worsening breathlessness,especially post CV line insertion is not considered.

Final outcome:Death/worsening morbidity.

Possible hidden nodes:Lack of individualisation of care,conspicuous gap between primary care and tertiary care,lack of motivation in caregivers to appropriately pursue all her problems,hierarchial system of learning disabling curiosity and self directed learning.

HFpEF Case 2

https://vamsikrishna1996.blogspot.com/2020/09/50f-presented-with-sob-and-pedal-edema.html

Patient problem-Dyspnea and anasarca

Individual level:Edema preceding dyspnea,right heart symptoms long preceding left heart symptoms,elevated blood sugar levels at hospitalization,arthritis limiting daily activities.

Community level:Best possible workup of dyspnea not done.No past reports of renal function or cardiac status,poor evaluation of cause of hypertension,no x rays of involved arthritic joints,prompt screening of diabetes was not pursued.

Medical system level:Poor evaluation of heart failure.Right sided symptoms preceding left sided symptoms by 4 years.Complete evaluation explaining heart failure and arthritis lacking,further workup to confirm diabetes(after elevated GRBS levels) not pursued.XRays of involved joints not taken,optimisation of antihypertensive therapy not prioritised,no workup for renal function,blanket term 'HFpEF' applied and discharged,workup for reversible heart failure not pursued.

Final outcome:Death/worsening morbidity.

HFpEF Case 3

https://sravanivv180.blogspot.com/2022/02/cbble-udhc-similar-cases-case-of-m-with.html

Patient problem:Dyspnea,pedal edema.

Family/community level:Best possible workup of pedal edema not done.No past reports of renal function or cardiac status,poor evaluation of cause of hypertension.

Medical system problems:Low quality of data documentation,generic one size fits all therapy for any patient with ckd,cause of ckd unknown,patient presented with breathlessness as her chief concern and worsened further in hospital with same problem(no audit for this),cause of anemia poorly evaluated.

Final outcome:?