Abstract 7: Patient and Physician Discordance in Reporting Symptoms of Angina: Insights from the Angina Prevalence and Provider Evaluation of Angina Relief (APPEAR) Study
Bibliographic record
Abstract
Background: Eradication/minimization of angina is a primary therapeutic goal in the management of stable coronary artery disease (CAD). However, eliciting the presence/frequency of patients’ angina can be challenging, particularly in a busy outpatient clinic. We independently measured and compared patients’ and physicians’ assessments of the frequency of angina in US outpatient cardiology practices. Methods: From the ACC NCDR PINNACLE registry, we identified 23 practices and conducted a cross-sectional study of patients with stable CAD. Using the SAQ Angina Frequency (AF) scale, patients’ angina was categorized as daily/weekly (SAQ AF Score <60), monthly (SAQ AF Score=60-99) and none (SAQ AF Score=100). Kappa statistics were used to assess agreement between physicians’ and patients’ reported angina. Results: Among 1153 outpatients with stable CAD from 23 cardiology clinics, 8% reported daily/weekly, 24% monthly and 68% no angina. When patients reported daily/weekly, monthly or no angina symptoms, physicians agreed 70%, 16% and 94% of the time respectively, with physicians reporting no angina a quarter of the time in patients with weekly or greater angina (Figure). Agreement between patients and physician reports, as determined with a Kappa Statistic, was 0.41 (95% CI=0.36, 0.44) Conclusion: There was discordance between patient and physician reports of angina, especially among patients who reported having infrequent angina over the past 4 weeks. Moreover, physicians reported no angina among 1 of 4 patients having daily/weekly symptoms. Improving the communication between patients and physicians about the presence of angina may improve patients’ treatment and outcomes. These results support recent proposals to include patient-reported outcomes measures in routine clinical care, which may support better recognition, by physicians, of patients’ symptoms and improve treatment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.045 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".