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 distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".