Department of Cardiology, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornall Rd, Kansas City, MO 64111, USA.
Department of Cardiology, Duke University, Durham, NC 11576, USA.
Eur Heart J Qual Care Clin Outcomes. 2022 Mar 2;8(2):161-168. doi: 10.1093/ehjqcco/qcab078.
In contrast to patient-reported health status measures (such as the Kansas City Cardiomyopathy Questionnaire), the New York Heart Association class is based on a physician's assessment of heart failure symptoms and functional limitations on behalf of the patient. We sought to determine the concordance and predictors of physician under- and overestimation of symptoms prior to and after transcatheter aortic valve replacement (TAVR).
The analytic cohort included 172 667 patients within the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry who underwent transfemoral TAVR. At baseline, physicians underestimated patients' symptoms in 47.4%, correctly assessed symptoms in 26.6%, and overestimated symptoms in 26.0%. At 30 days after TAVR, these proportions were 22.8%, 50.3%, and 26.9%, respectively. Using nominal logistic regression with random intercepts to account for within-hospital clustering, we found that physicians were more likely to incorrectly estimate patients' symptoms when patients were older, women, had a prior stroke, had severe lung disease, had atrial fibrillation, or were more obese. There was marked variability in the rates of underestimation, correct estimation, and overestimation across the 641 sites.
Among patients undergoing treatment for severe aortic stenosis, physicians estimate patients' symptoms and functional status poorly both prior to and after TAVR, with different patterns. These findings emphasize the need to collect patient-reported health status to more reliably assess the benefits of TAVR in routine clinical practice.
与患者报告的健康状况衡量标准（如堪萨斯城心肌病问卷）不同，纽约心脏协会（NYHA）分级基于医生对心力衰竭症状和患者功能限制的评估。我们旨在确定在经导管主动脉瓣置换术（TAVR）前后，医生对症状的低估和高估的一致性及其预测因素。
分析队列包括在经股动脉 TAVR 接受治疗的胸外科医师学会/美国心脏病学会经导管瓣膜治疗注册中心内的 172667 例患者。在基线时，医生低估了 47.4%患者的症状，正确评估了 26.6%的症状，高估了 26.0%的症状。在 TAVR 后 30 天，这些比例分别为 22.8%、50.3%和 26.9%。使用具有随机截距的名义逻辑回归来解释医院内聚类，我们发现，当患者年龄较大、女性、有既往卒中、严重肺部疾病、房颤或更肥胖时，医生更有可能错误地估计患者的症状。在 641 个地点中，存在严重的低估、正确估计和高估的发生率差异。
在接受严重主动脉瓣狭窄治疗的患者中，医生在 TAVR 前后均对患者的症状和功能状态评估不佳，且存在不同的模式。这些发现强调了在常规临床实践中收集患者报告的健康状况以更可靠地评估 TAVR 的益处的必要性。
