Patient perception and provider assessment of severity of heart failure as predictors of hospitalization

Usha Subramanian, Michael Weiner, Irmina Gradus-Pizlo, Jingwei Wu, Wanzhu Tu, Michael Murray

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

OBJECTIVE: To assess the agreement between 2 methods of assigning New York Heart Association (NYHA) functional class to patients with chronic heart failure (CHF): deriving NYHA class from self-report interview data versus clinician assignment. To then determine the ability of each method to predict all-cause hospitalization. METHODS: Adults with CHF ≥ 50 years old from an urban health system in Indianapolis, Indiana, were administered the Kansas City Cardiomyopathy Questionnaire (a validated CHF symptom questionnaire) at baseline. Patient self-reported functional data were then used to derive NYHA class. Clinical providers who were blinded to patients' questionnaire data independently assessed NYHA functional class. We used a weighted κ statistic to evaluate the agreement between the NYHA class from patient-derived and that from provider-assigned methods. We then assessed the ability of patient and provider NYHA to predict time to hospitalization using Cox proportional hazards models. RESULTS: Of 156 patients with complete 6-month follow-up (mean age 63 years ± 9 SD, 53% African American, and 68% women), the correlation coefficient was 0.43 between the patient-derived and provider-assigned NYHA methods. The weighted κ statistic was 0.278, and the 95% confidence interval was 0.18 to 0.37, indicating only slight agreement. Patients classified themselves in worse categories than did their providers. Provider-assigned NYHA was a better predictor of hospitalization (P = .06). CONCLUSIONS: There is only slight agreement between patient-derived and clinician-assigned NYHA functional class. A different approach with patients may be needed if providers hope to use patients' reports to identify those at risk for hospitalization.

Original languageEnglish
Pages (from-to)89-98
Number of pages10
JournalHeart and Lung: Journal of Acute and Critical Care
Volume34
Issue number2
DOIs
StatePublished - Mar 2005

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Hospitalization
Heart Failure
Aptitude
Urban Health
Cardiomyopathies
Proportional Hazards Models
African Americans
Self Report
Confidence Intervals
Interviews

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Critical Care and Intensive Care Medicine
  • Pulmonary and Respiratory Medicine

Cite this

Patient perception and provider assessment of severity of heart failure as predictors of hospitalization. / Subramanian, Usha; Weiner, Michael; Gradus-Pizlo, Irmina; Wu, Jingwei; Tu, Wanzhu; Murray, Michael.

In: Heart and Lung: Journal of Acute and Critical Care, Vol. 34, No. 2, 03.2005, p. 89-98.

Research output: Contribution to journalArticle

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