Key result
Physician assessment of ADHF dyspnea correlates poorly with patient self-assessment.
Why the study?
The level of agreement between physician and patient self-reported measures of dyspnea severity during acute decompensated heart failure needed to be assessed.
Does physician assessment of dyspnea severity change agree with patient self-reported assessment in patients with acute decompensated heart failure?
Observational (n=112)
Does physician assessment of dyspnea severity change agree with patient self-reported assessment in patients with acute decompensated heart failure?
Wide limits of agreement and low kappa values demonstrate that physician assessment cannot substitute for patient self-assessment of dyspnea during acute decompensated heart failure.
Answers are grounded in this paper and cite their sources.
Physician-patient dyspnea ratings may differ in ADHF; leaves open standardized measures for trials and research.
This study assessed agreement between physician and patient self-reported measures of dyspnea severity during acute decompensated heart failure (ADHF). Both the physician and patient measured the change in dyspnea severity over 1 hour using 2 methods: (1) the difference of two static dyspnea measures (STATIC) and (2) a single transitional measure (TRANS). Likert scales and visual analog scales (VASs) were used. Data on 112 patients were analyzed. The mean difference between physician and patient VAS scores was 1 mm (limits of agreement: -54 to 56 mm) using the STATIC data. For TRANS data, the mean difference was 5 mm (limits of agreement: -75 to 86 mm). For the Likert scales, the weighted kappa was 0.13 and 0.23 for STATIC and TRANS data, respectively. The wide limits of agreement restrict our ability to substitute physician assessment for patient self-assessment of dyspnea in patients with ADHF.
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Smithline et al. (2009) conducted an observational in Acute decompensated heart failure (ADHF) (n=112). Physician assessment of dyspnea severity change (using static and transitional visual analog scales and Likert scales) vs. Patient self-reported assessment of dyspnea severity change was evaluated on Agreement between physician and patient self-reported measures of dyspnea severity change over 1 hour (MD 1 mm (STATIC VAS); MD 5 mm (TRANS VAS); weighted kappa 0.13 (STATIC Likert) and 0.23 (TRANS Likert)). Physician assessment of dyspnea in ADHF had poor agreement with patient self-assessment, with wide VAS limits of agreement (-54 to 56 mm STATIC; -75 to 86 mm TRANS) and low kappa (0.13 and 0.23).
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