Algorithm to reduce inter-rater variability in assessment of intermacs patient profiles

Area of Science:

• Cardiology
• Medical Device Technology
• Clinical Informatics

Background:

• Intermacs Patient Profiles (IPP) are subjective assessments of patient acuity at durable left ventricular assist device (dLVAD) implantation.
• Previous studies highlight significant provider variability in IPP assignment.
• This variability can impact clinical decision-making and patient management.

Purpose of the Study:

• To develop and validate a novel algorithm for deriving Intermacs Patient Profiles (IPP).
• To assist clinicians in standardizing patient acuity of illness assessments for dLVAD implantation.
• To reduce inter-rater variability in IPP assignments.

Main Methods:

• Twenty standardized clinical vignettes representing the full spectrum of patient acuity for dLVAD were created.
• An algorithm was developed to assign IPPs (1-7).
• Fifteen heart failure specialists assigned IPPs in two phases: unaided (Phase One) and algorithm-assisted (Phase Two), with inter-rater variability assessed using the Pitman-Morgan Test and coefficient of variation (CoV).

Main Results:

• The algorithm demonstrated a significant reduction in CoV for 3 out of 20 vignettes.
• One vignette showed a significant increase in CoV.
• The majority of vignettes showed no significant change in CoV, suggesting the algorithm's potential for standardization.

Conclusions:

• The developed algorithm successfully reproduces IPP assignments made by experienced heart failure specialists.
• This tool can aid clinicians in patient decision-making for dLVAD implantation.
• The algorithm may also streamline patient screening for randomized clinical trials.