Warraich Haider Javed, Allen Larry A, Mukamal Kenneth J, Ship Amy, Kociol Robb D
Division of Cardiology, Department of Medicine, Duke University Hospital, Durham NC, USA
University of Colorado School of Medicine, Aurora, CO, USA.
Palliat Med. 2016 Jul;30(7):684-9. doi: 10.1177/0269216315626048. Epub 2016 Jan 14.
Anticipating adverse outcomes guides decisions but can be particularly challenging in heart failure.
We sought to assess the accuracy and comfort of physicians in predicting prognosis in heart failure.
Cross-sectional survey
PARTICIPANTS/SETTING: Faculty and trainees in internal medicine, cardiology, and oncology estimated survival for three standardized patients: (1) 59-year-old patient with stage IV lung cancer; (2) 79-year-old woman with New York Heart Association class 4 heart failure symptoms and preserved ejection fraction; and (3) 40-year-old man with New York Heart Association class 3 heart failure symptoms and reduced ejection fraction of 20%. Survival predictions were derived from surveillance, epidemiology, and end results-Medicare database and the Seattle Heart Failure Model. Accuracy was defined as <2-fold difference between the clinician and model estimate.
Totally, 79% (338/427) of participants responded. Physicians were more accurate in survival estimates for lung cancer than heart failure (74% vs 48%, respectively; p < 0.001). Cardiologists were more accurate in predicting survival in heart failure symptoms and reduced ejection fraction compared to generalists (67% vs 45%; p = 0.005) and oncologists (39%; p = 0.041) but no different at predicting heart failure symptoms and preserved ejection fraction. Cardiologists predicted longer survival in heart failure compared to others (p < 0.05). Physicians felt more uncomfortable discussing palliative care with heart failure patients compared to lung cancer.
Less than half of physicians accurately estimate survival in heart failure. Cardiologists were more accurate than other specialties for heart failure symptoms and reduced ejection fraction but no different for heart failure symptoms and preserved ejection fraction.
预测不良结局有助于指导决策，但在心衰领域可能极具挑战性。
我们旨在评估医生预测心衰预后的准确性和舒适度。
横断面调查
参与者/研究背景：内科、心脏病学和肿瘤学的教员及实习生对三名标准化患者的生存情况进行了估计：（1）一名59岁的IV期肺癌患者；（2）一名79岁、纽约心脏协会心功能4级且射血分数保留的心衰症状女性；（3）一名40岁、纽约心脏协会心功能3级且射血分数降低至20%的心衰症状男性。生存预测来自监测、流行病学和最终结果 - 医疗保险数据库以及西雅图心衰模型。准确性定义为临床医生和模型估计值之间的差异小于2倍。
共有79%（338/427）的参与者做出了回应。医生对肺癌生存情况的估计比心衰更准确（分别为74%和48%；p < 0.001）。与普通内科医生（67%对45%；p = 0.005）和肿瘤学家（39%；p = 0.041）相比，心脏病学家在预测心衰症状和射血分数降低患者的生存情况时更准确，但在预测心衰症状且射血分数保留的患者时无差异。与其他医生相比，心脏病学家预测的心衰患者生存期更长（p < 0.05）。与肺癌患者相比，医生在与心衰患者讨论姑息治疗时感觉更不自在。
不到一半的医生能准确估计心衰患者的生存期。对于心衰症状和射血分数降低的情况，心脏病学家比其他专科医生更准确，但对于心衰症状和射血分数保留的情况则无差异。
