Abstract
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.
Résumé
Contexte
Les données issues d’études antérieures indiquent que le pronostic établi par les
cardiologues et les médecins de famille est rarement précis. Il existe des modèles
prédictifs d’une précision satisfaisante pour estimer la mortalité chez les patients
présentant une insuffisance cardiaque (IC), mais rares sont les médecins qui les utilisent.
Nous avons comparé la précision relative des prédictions faites par les médecins à
celles obtenues à l’aide de modèles à l’égard de l’estimation de la survie à 1 an
chez des patients ambulatoires présentant une IC.
Méthodologie
Nous avons mené une étude transversale unicentrique sur les cas de 150 patients ambulatoires
consécutifs âgés de > 18 ans présentant une IC et une fraction d’éjection ventriculaire
gauche ≤ 40 %. Le cardiologue et le médecin de famille de chacun des patients ont
évalué la survie à 1 an, et nous avons calculé les scores de survie prédite à l'aide
de 3 modèles : HF Meta-Score, SHFM (Seattle Heart Failure Model) et MAGGIC (Meta-Analysis Global Group in Chronic HF). Nous avons ensuite comparé la précision des prédictions des médecins avec celle
des prédictions des modèles en calculant la corrélation intraclasse (CIC).
Résultats
La survie médiane prédite par les cardiologues spécialisés en IC était inférieure
(médiane de 80 %, intervalle interquartile [IIQ] : de 61 % à 90 %) à celle prédite
par les médecins de famille (médiane de 90 %, IIQ : de 70 % à 99 %, p = 0,08). La survie médiane à 1 an calculée au moyen des modèles HF Meta-Score (94,6
%), SHFM (95,4 %) et MAGGIC (88,9 %) était équivalente ou supérieure aux estimations
des médecins. La concordance entre les prédictions des cardiologues spécialisés en
IC (CIC : de 0,28 à 0,41) et des médecins de famille (CIC : de 0,43 à 0,47) et les
scores de survie à 1 an prédits par les modèles était faible, tandis que les prédictions
des trois modèles concordaient bien (CIC > 0,65).
Conclusions
Les cardiologues spécialisés en IC ont sous-estimé la survie par rapport aux médecins
de famille, tandis que les deux groupes de médecins ont fait des prédictions inférieures
à celles des modèles. Les résultats de l'étude fournissent des preuves supplémentaires
de l'inexactitude potentielle des prédictions de la survie faites par les médecins
chez les patients ambulatoires présentant une IC. Il conviendrait de valider ces résultats
au moyen d'études longitudinales comportant des données sur la survie réelle.
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Article info
Publication history
Published online: July 25, 2019
Accepted:
July 15,
2019
Received:
May 13,
2019
Footnotes
See editorial by Heckman et al., pages 19–21 of this issue.
See page 90 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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- The Role of Physicians in the Era of Big DataCanadian Journal of CardiologyVol. 36Issue 1
