Patient perception and provider assessment of severity of heart failure as predictors of hospitalization
Patient perception and provider assessment of severity of heart failure as predictors of hospitalization
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DOI：
10.1016/j.hrtlng.2004.05.002
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发表时间：
2005-03-01
期刊：
影响因子：
2.8
通讯作者：
Murray, MD
中科院分区：
文献类型：
--
作者：
Subramanian, U;Weiner, M;Murray, MD
目的：评估纽约心脏协会(NYHA)对慢性心力衰竭(CHF)患者进行功能分级的两种方法之间的一致性：根据自我报告访谈数据与临床医生分配得出NYHA分级。方法：来自印第安纳州印第安纳波利斯城市卫生系统的50岁CHF患者在基线时接受了堪萨斯城心肌病问卷(一份有效的CHF症状问卷)。然后使用患者自我报告的功能数据得出NYHA分级。对患者问卷数据视而不见的临床提供者独立评估NYHA功能等级。我们使用加权K统计量来评估来自患者来源的NYHA分类和来自提供者指定方法的NYHA分类之间的一致性。然后，我们使用COX比例风险模型评估了患者和提供者NYHA预测住院时间的能力。结果：在156名完成6个月随访的患者(平均年龄63岁+/-9 SD，53%非裔美国人，68%女性)中，患者派生的方法与提供者分配的NYHA方法之间的相关系数为0.43。加权K统计量为0.278，95%可信区间为0.18至0.37，表明仅有轻微的一致性。患者将自己归类到比提供者更糟糕的类别中。提供者分配的NYHA是住院的更好的预测因子(P=0.06)。结论：患者派生的NYHA功能分级与临床医生分配的NYHA功能分级之间只有轻微的一致性。如果提供者希望使用患者的报告来识别那些有住院风险的人，可能需要对患者采取不同的方法。
OBJECTIVE: To assess the agreement between 2 methods of assigning New York Heart Association (NYHA) functional class to patients with chronic heart failure (CHF): deriving NYHA class from self-report interview data versus clinician assignment. To then determine the ability of each method to predict all-cause hospitalization.METHODS: Adults with CHF >= 50 years old from an urban health system in Indianapolis, Indiana, were administered the Kansas City Cardiomyopathy Questionnaire (a validated CHF symptom questionnaire) at baseline. Patient self-reported functional data were then used to derive NYHA class. Clinical providers who were blinded to patients' questionnaire data independently assessed NYHA functional class. We used a weighted K statistic to evaluate the agreement between the NYHA class from patient-derived and that from provider-assigned methods. We then assessed the ability of patient and provider NYHA to predict time to hospitalization using Cox proportional hazards models.RESULTS: Of 156 patients with complete 6-month follow-up (mean age 63 years +/- 9 SD, 53% African American, and 68% women), the correlation coefficient was 0.43 between the patient-derived and provider-assigned NYHA methods. The weighted K statistic was 0.278, and the 95% confidence interval was 0.18 to 0.37, indicating only slight agreement. Patients classified themselves in worse categories than did their providers. Provider-assigned NYHA was a better predictor of hospitalization (P =.06).CONCLUSIONS: There is only slight agreement between patient-derived and clinician-assigned NYHA functional class. A different approach with patients may be needed if providers hope to use patients' reports to identify those at risk for hospitalization.