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.
Can J Cardiol. 2020 Jan;36(1):84-91. doi: 10.1016/j.cjca.2019.07.623. Epub 2019 Jul 25.
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.
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).
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).
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.
先前的证据表明，心脏病专家和家庭医生在预测患者预后方面的准确性有限。存在预测模型，可以准确预测心力衰竭（HF）患者的死亡率；然而，医生很少使用这些模型。我们评估了医生与模型预测在估计心力衰竭门诊患者 1 年生存率方面的相对准确性。
我们进行了一项单中心横断面研究，涉及 150 例年龄大于 18 岁、左心室射血分数≤40%的心力衰竭门诊患者。每位患者的心脏病专家和家庭医生提供了他们预测的 1 年生存率，使用 3 种模型计算预测的生存率评分：HF Meta-Score、西雅图心力衰竭模型（SHFM）和慢性心力衰竭 Meta 分析全球组（MAGGIC）评分。我们使用组内相关系数（ICC）比较了医生和模型预测之间的准确性。
HF 心脏病专家预测的中位生存率较低（中位数为 80%，四分位距[IQR]：61%-90%），低于家庭医生预测的生存率（中位数为 90%，IQR 为 70%-99%，P=0.08）。HF Meta-Score（94.6%）、SHFM（95.4%）和 MAGGIC（88.9%）计算的 1 年中位生存率证明与医生估计值一样高或更高。与 1 年模型预测生存率评分相比，HF 心脏病专家（ICC 0.28-0.41）和家庭医生（ICC 0.43-0.47）之间的一致性有限，而 3 种模型之间的一致性较好（ICC>0.65）。
与家庭医生相比，HF 心脏病专家低估了生存率，而医生的估计值均低于计算模型的估计值。我们的研究结果进一步证明了心力衰竭门诊患者中医生生存预测的潜在不准确性。这些结果应在收集实际生存率的纵向研究中进行验证。
