P5443The lack of clinical awareness towards the diagnosis of mitral regurgitation. Insights from a European survey
Bibliographic record
Abstract
Background: Mitral regurgitation (MR) is the most frequent valvular disease in the community. However, the current knowledge and application of Guidelines on diagnosis and evaluation of MR are not well known. Purpose: The Education Committee of the ESC and AXDEV Group performed a mixed-methods educational needs assessment, which included a case-based evaluation, in a wide panel of practitioners in Europe. Methods: The quantitative portion of the needs assessment included 3 case scenarios (asymptomatic severe primary MR, symptomatic severe primary MR in the elderly and symptomatic severe secondary MR) and was conducted online from March to May 2016 in 7 countries: France, Germany, Italy, Poland, Spain, Sweden and the United Kingdom. 554 practitioners participated in the study, 51 in the exploratory qualitative phase, and 503 in the quantitative phase. The quantitative phase case scenarios were answered by 108 primary care physicians (PCP), 203 general and 192 sub-specialized cardiologists. Results: Cardiac auscultation was performed systematically by 54% of PCPs and only in the presence of cardiac symptoms by 31%. In addition, 40% of PCPs did not perform systematic auscultation after mitral valve repair. 20% of PCPs considered that the lack of symptoms was discordant with severe MR. In an elderly patient with severe MR and comorbidities, dyspnoea was more frequently considered as severe by PCPs (69% of participants) than by cardiologists (29% of participants). Cardiologists appropriately interpreted echocardiographic findings with regards to mechanism and quantitation of symptomatic primary MR (75% and 75%, respectively) and of asymptomatic primary MR (87% and 86%, respectively). The diagnosis of secondary MR was correct in 93% of cases, although it was based on left ventricular dysfunction in 79% of cases and on analysis of leaflet structure and movement in only 14%. In contrast, secondary MR was quantitated as severe by only 44% of cardiologists. Only 44% of cardiologists requested the measurement of tricuspid annulus diameter before surgery for asymptomatic severe primary MR.
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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 | 0.004 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".