Agreement between patient-reported and cardiology-adjudicated medical history in patients with possible ischemic chest pain: an observational study

Iliceto, Alessandro, Berndt, Sara Louise, Greenslade, Jaimi H., Parsonage, William A., Hammett, Christopher, Than, Martin, Hawkins, Tracey, Parker, Kate, O'Kane, Shannen and Cullen, Louise (2016) Agreement between patient-reported and cardiology-adjudicated medical history in patients with possible ischemic chest pain: an observational study. Critical Pathways in Cardiology, 15 3: 121-125. doi:10.1097/HPC.0000000000000082


Author Iliceto, Alessandro
Berndt, Sara Louise
Greenslade, Jaimi H.
Parsonage, William A.
Hammett, Christopher
Than, Martin
Hawkins, Tracey
Parker, Kate
O'Kane, Shannen
Cullen, Louise
Title Agreement between patient-reported and cardiology-adjudicated medical history in patients with possible ischemic chest pain: an observational study
Journal name Critical Pathways in Cardiology   Check publisher's open access policy
ISSN 1535-2811
1535-282X
Publication date 2016-09-01
Sub-type Article (original research)
DOI 10.1097/HPC.0000000000000082
Open Access Status Not yet assessed
Volume 15
Issue 3
Start page 121
End page 125
Total pages 5
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Abstract Obtaining an accurate medical history is essential in the assessment of patients, particularly in emergency department (ED) patients with acute chest pain, as there can be a time imperative for diagnosis and commencement of treatment. We aimed to evaluate reliability of patient-reported compared with physician-adjudicated medical history by assessing patient's recall and communication of personal events and its influence on the accuracy of the medical history.

A total of 776 patients presenting at ED with suspected cardiac chest pain were recruited. Data collection included self-reported patient history, electrocardiogram testing, and troponin I measurements. Independent assessment of risk factors and medical history was adjudicated by cardiologists. Diagnosis of acute coronary syndrome (ACS) at 30 days after presentation was assessed. Cohen's kappa measured patient-cardiologist agreement. Cardiologist adjudicated events were taken as true to assess accuracy.

A total of 83 participants (10.7%) were diagnosed with ACS at 30 days after presentation. "Previous coronary artery bypass grafting" showed highest agreement (K = 1.00) between patient-reported and cardiologist-adjudicated events. Lowest agreement between patient-reported and cardiologist-adjudicated events was found for "prior ventricular dysrhythmia" (K = 0.33). Accuracy of reported "prior congestive heart failure" differed significantly between patients with and without diagnosed ACS at 30 days (92.8% and 97.5%, respectively).

Accuracy of patient's recall and communication of medical history and risk factors was substantial but not perfect in the assessment of patients with ACS in the ED context. Our study reinforces the importance in the utilization of medical records and collateral information to address possible discrepancies in the medical history and improve patient care.
Formatted abstract
Objective: Obtaining an accurate medical history is essential in the assessment of patients, particularly in emergency department (ED) patients with acute chest pain, as there can be a time imperative for diagnosis and commencement of treatment. We aimed to evaluate reliability of patient-reported compared with physician-adjudicated medical history by assessing patient's recall and communication of personal events and its influence on the accuracy of the medical history.

Methods: A total of 776 patients presenting at ED with suspected cardiac chest pain were recruited. Data collection included self-reported patient history, electrocardiogram testing, and troponin I measurements. Independent assessment of risk factors and medical history was adjudicated by cardiologists. Diagnosis of acute coronary syndrome (ACS) at 30 days after presentation was assessed. Cohen's kappa measured patient-cardiologist agreement. Cardiologist adjudicated events were taken as true to assess accuracy.

Results: A total of 83 participants (10.7%) were diagnosed with ACS at 30 days after presentation. "Previous coronary artery bypass grafting" showed highest agreement (K = 1.00) between patient-reported and cardiologist-adjudicated events. Lowest agreement between patient-reported and cardiologist-adjudicated events was found for "prior ventricular dysrhythmia" (K = 0.33). Accuracy of reported "prior congestive heart failure" differed significantly between patients with and without diagnosed ACS at 30 days (92.8% and 97.5%, respectively).

Conclusions: Accuracy of patient's recall and communication of medical history and risk factors was substantial but not perfect in the assessment of patients with ACS in the ED context. Our study reinforces the importance in the utilization of medical records and collateral information to address possible discrepancies in the medical history and improve patient care.
Keyword Acute coronary syndrome
Chest pain
Emergency
Ischemia
Medical history
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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