Division of Cardiology, Duke University School of Medicine, Durham, NC (S.S.).
Duke Molecular Physiology Institute, Durham, NC (S.S.).
Circ Heart Fail. 2023 Feb;16(2):e010069. doi: 10.1161/CIRCHEARTFAILURE.122.010069. Epub 2022 Dec 2.
Heuristic biases are increasingly recognized, and potentially modifiable, contributors to patient care and outcomes. Left digit bias is a cognitive bias where continuous variables are categorized by their left-most digit. The impact of this heuristic bias applied to patient age on quality of care in heart failure has not been explored.
We examined participants admitted from 2005 to 2021 in the Get With The Guidelines-Heart Failure registry. To create 2 naturally randomized groups, isolating the effect of left digit bias, we dichotomized patients into those discharged within 60 days prior to their 80th birthday (N=4238) and those discharged within 60 days after their 80th birthday (N=4329). We performed multivariable logistic regression to assess the association between discharge date relative to 80th birthday and several in-hospital quality metrics and in-hospital outcomes. Among Medicare participants (N=2759), we performed adjusted Cox regression to analyze the relationship between discharge date and risk of 1-year mortality or readmission.
Among 8567 patients, 50.4% were female, 73% were non-Hispanic White, and 42.9% had an ejection fraction ≤40%. Discharge date relative to 80th birthday was not associated with numerous in-hospital quality metrics or in-hospital outcomes on unadjusted or adjusted logistic regression. Among Medicare beneficiaries, there was no association between discharge date and risk of mortality or readmission at 1-year postdischarge (hazard ratio, 1.03 [95% CI, 0.95-1.12]; =0.52).
In a large registry of patients hospitalized for heart failure, we did not detect a left digit bias' with respect to age at discharge, which resulted in differential quality of care or outcomes.
启发式偏差越来越被认为是影响患者护理和结局的、潜在可改变的因素。左位数偏差是一种认知偏差，其中连续变量根据其最左边的数字进行分类。这种启发式偏差应用于患者年龄对心力衰竭患者护理质量的影响尚未得到探讨。
我们研究了 2005 年至 2021 年在 Get With The Guidelines-Heart Failure 注册中心住院的患者。为了创建 2 个自然随机组，以隔离左位数偏差的影响，我们将患者分为在 80 岁生日前 60 天内出院的（N=4238）和在 80 岁生日后 60 天内出院的（N=4329）。我们进行多变量逻辑回归分析，以评估出院日期与多项院内质量指标和院内结局之间的关系。在 Medicare 参与者中（N=2759），我们进行了调整后的 Cox 回归分析，以分析出院日期与 1 年死亡率或再入院风险之间的关系。
在 8567 名患者中，50.4%为女性，73%为非西班牙裔白人，42.9%的射血分数≤40%。在未经调整或调整后的逻辑回归中，出院日期与许多院内质量指标或院内结局均无关联。在 Medicare 受益人中，出院日期与 1 年后的死亡率或再入院风险之间没有关联（危险比，1.03[95%CI，0.95-1.12]；P=0.52）。
在一项大型心力衰竭住院患者注册研究中，我们没有发现与出院时年龄相关的左位数偏差，这导致了护理质量或结局的差异。
