PMID- 31735429
OWN - NLM
STAT- MEDLINE
DCOM- 20200723
LR  - 20200723
IS  - 1916-7075 (Electronic)
IS  - 0828-282X (Linking)
VI  - 36
IP  - 1
DP  - 2020 Jan
TI  - Physician Judgement vs Model-Predicted Prognosis in Patients With Heart Failure.
PG  - 84-91
LID - S0828-282X(19)31105-5 [pii]
LID - 10.1016/j.cjca.2019.07.623 [doi]
AB  - BACKGROUND: Previous evidence suggests that cardiologists and family doctors have 
      limited accuracy in predicting patient prognosis. Predictive models with 
      satisfactory accuracy for estimating mortality in patients with heart failure 
      (HF) exist; physicians, however, seldom use these models. We evaluated the 
      relative accuracy of physician vs model prediction to estimate 1-year survival in 
      ambulatory patients with HF. METHODS: We conducted a single-centre 
      cross-sectional study involving 150 consecutive ambulatory patients with HF >18 
      years of age with a left ventricular ejection fraction </=40%. Each patient's 
      cardiologist and family doctor provided their predicted 1-year survival, and 
      predicted survival scores were calculated using 3 models: HF Meta-Score, Seattle 
      Heart Failure Model (SHFM), and Meta-Analysis Global Group in Chronic HF (MAGGIC) 
      score. We compared accuracy between physician and model predictions using 
      intraclass correlation (ICC). RESULTS: Median predicted survival by HF 
      cardiologists was lower (median 80%, interquartile range [IQR]: 61%-90%) than 
      that predicted by family physicians (median 90%, IQR 70%-99%, P = 0.08). One-year 
      median survival calculated by the HF Meta-Score (94.6%), SHFM (95.4%), and MAGGIC 
      (88.9%,) proved as high or higher than physician estimates. Agreement among HF 
      cardiologists (ICC 0.28-0.41) and family physicians (ICC 0.43-0.47) when compared 
      with 1-year model-predicted survival scores proved limited, whereas the 3 models 
      agreed well (ICC > 0.65). CONCLUSIONS: HF cardiologists underestimated survival 
      in comparison with family physicians, whereas both physician estimates were lower 
      than calculated model estimates. Our results provide additional evidence of 
      potential inaccuracy of physician survival predictions in ambulatory patients 
      with HF. These results should be validated in longitudinal studies collecting 
      actual survival.
CI  - Copyright (c) 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All 
      rights reserved.
FAU - Buchan, Tayler A
AU  - Buchan TA
AD  - Ted Rogers Center for Heart Research, University Health Network, Toronto, 
      Ontario, Canada.
FAU - Ross, Heather J
AU  - Ross HJ
AD  - Ted Rogers Center for Heart Research, University Health Network, Toronto, 
      Ontario, Canada.
FAU - McDonald, Michael
AU  - McDonald M
AD  - Ted Rogers Center for Heart Research, University Health Network, Toronto, 
      Ontario, Canada.
FAU - Billia, Fillio
AU  - Billia F
AD  - Ted Rogers Center for Heart Research, University Health Network, Toronto, 
      Ontario, Canada.
FAU - Delgado, Diego
AU  - Delgado D
AD  - Ted Rogers Center for Heart Research, University Health Network, Toronto, 
      Ontario, Canada.
FAU - Duero Posada, Juan G
AU  - Duero Posada JG
AD  - Ted Rogers Center for Heart Research, University Health Network, Toronto, 
      Ontario, Canada.
FAU - Luk, Adriana
AU  - Luk A
AD  - Ted Rogers Center for Heart Research, University Health Network, Toronto, 
      Ontario, Canada.
FAU - Guyatt, Gordon H
AU  - Guyatt GH
AD  - Department of Health Research Methods, Evidence, and Impact, McMaster University, 
      Hamilton, Ontario, Canada.
FAU - Alba, Ana C
AU  - Alba AC
AD  - Ted Rogers Center for Heart Research, University Health Network, Toronto, 
      Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, 
      McMaster University, Hamilton, Ontario, Canada. Electronic address: 
      carolina.alba@uhn.ca.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190725
PL  - England
TA  - Can J Cardiol
JT  - The Canadian journal of cardiology
JID - 8510280
SB  - IM
CIN - Can J Cardiol. 2020 Jan;36(1):19-21. PMID: 31787436
MH  - Cross-Sectional Studies
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/diagnosis/*epidemiology/physiopathology
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Ontario/epidemiology
MH  - *Practice Patterns, Physicians'
MH  - Prognosis
MH  - Reproducibility of Results
MH  - Retrospective Studies
MH  - Risk Assessment/*methods
MH  - Survival Rate/trends
MH  - Ventricular Function, Left/*physiology
EDAT- 2019/11/19 06:00
MHDA- 2020/07/24 06:00
CRDT- 2019/11/19 06:00
PHST- 2019/05/13 00:00 [received]
PHST- 2019/07/02 00:00 [revised]
PHST- 2019/07/15 00:00 [accepted]
PHST- 2019/11/19 06:00 [pubmed]
PHST- 2020/07/24 06:00 [medline]
PHST- 2019/11/19 06:00 [entrez]
AID - S0828-282X(19)31105-5 [pii]
AID - 10.1016/j.cjca.2019.07.623 [doi]
PST - ppublish
SO  - Can J Cardiol. 2020 Jan;36(1):84-91. doi: 10.1016/j.cjca.2019.07.623. Epub 2019 
      Jul 25.