Patient and Physician Discordance in Reporting Symptoms of Angina: Insights From the Angina Prevalence and Provider Evaluation of Angina Relief (APPEAR) Study

A principal goal of treating patients with coronary artery disease (CAD) is to minimize their angina and optimize their quality of life. In order to accomplish this, physicians must accurately assess the presence and frequency of patients’ angina. The accuracy with which cardiologists estimate their patients’ angina in contemporary, busy outpatient clinics across the United States (US) is unknown. Patients with an established diagnosis of CAD were enrolled across 25 US cardiology outpatient practices. These patients completed the Seattle Angina Questionnaire (SAQ) prior to their visit, which assesses the patient’s angina and quality of life over the prior 4 weeks. The SAQ angina frequency (AF) domain categorized patients’ angina as daily/weekly (SAQ AF Score ≤60), monthly (SAQ AF Score=61-99), or none (SAQ AF Score=100). Immediately after the visit, cardiologists estimated the frequency of their patients’ angina using the same categories. A Cohen weighted kappa statistic was used to assess the agreement between patient reported and cardiologist-estimated angina. Among 1257 outpatients with CAD, 67% reported no angina over the 4 weeks prior to the office visit, 25% reported monthly angina, and 8% daily/weekly angina. Agreement between patients’ and cardiologists’ reports, as assessed by the kappa statistic, was 0.39 indicating a modest agreement. When patients reported no angina, cardiologists accurately estimated this 93% of the time. However, when patients reported monthly or daily/weekly angina symptoms, cardiologists agreed 17% and 69% of the time, respectively. In addition, among patients with daily/weekly angina, 26% were noted as having no angina by their treating physicians. Among outpatients with stable CAD, there is substantial discordance between patient reported and cardiologist-estimated burden of angina. Inclusion of patient-reported health status measures in routine clinical care may support better recognition of patients’ symptoms by physicians.

Name thesis:degree_name

M.S.

Level thesis:degree_level

Masters

Discipline thesis:degree_discipline

Bioinformatics (UMKC)

Grantor

University of Missouri--Kansas City

Year dc:date.issued

2016

Author dc:creator

• Shafiq, Ali

Advisor dc:contributor.advisor

• Buchanan, Donna M.

Language dc:language.iso

en_US

Handle dc:identifier.uri

https://hdl.handle.net/10355/49258

OAI identifier oai:identifier

oai:mospace.umsystem.edu:10355/49258