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Do physicians estimate reliably the cardiovascular risk of hypertensive patients?
G Chatellier1, A Blinowska, J Menard
1Service d'Informatique Medicale, and Departement d'Hypertension, Hopital Broussais, 96 rue Didot, 75674 Paris CEDEX 14, FRANCE.
Insights
Senior hypertension specialists showed moderate reproducibility in assessing cardiovascular disease (CVD) risk in hypertensive patients without computer aids. This suggests potential bias and inconsistency in physician judgment, highlighting the need for decision support tools.
Area of Science:
- Cardiology
- Medical Informatics
- Clinical Decision Making
Background:
- Individualized hypertension management is recommended.
- Physician ability to predict cardiovascular disease (CVD) risk without computer aid is unknown.
Purpose of the Study:
- To determine if senior hypertension specialists could reproducibly assess CVD risk in hypertensive patients.
Main Methods:
- 100 patient records from the ARTEMIS database were analyzed.
- Six physicians assessed patient CVD risk (low, moderate, high) twice over one month.
- Patient data included demographics, medical history, clinical examination, and biological tests.
Main Results:
- Intra-physician agreement was only moderate (kappa values ranging from 0.207 to 0.658).
- Assigned risk categories varied significantly among physicians.
- One physician overestimated risk, one underestimated it, while three aligned with Framingham predictions.
Conclusions:
- Bias and lack of reproducibility impact physician judgment in CVD risk assessment for hypertensive patients.
- Computer aids may lead to more rational assessments and improved decision-making in hypertension management.
Abstract:
For hypertension management, it is increasingly recommended to individualize treatment according to the individual patient's characteristics. However, the ability of physicians to predict the patient's risk in the absence of a computer aid is unknown. Our aim was to determine if senior hypertension specialists were able to assess reproducibly cardiovascular disease (cvd) risk in hypertensive patients. The records of 100 patients were selected at random from the ARTEMIS database. The group comprised 53% of males, mean age was 43.7 (15), blood pressure 160 (25) / 99 (12) mmhg and serum cholesterol 5.6 (1.1) mmol/l. The records were summarized on a standardized form. Nineteen items were devoted to general characteristics and medical history of patients, 15 to clinical examination and 7 to biological tests. These items have been chosen because they were used in the framingham cvd risk prediction equation and/or had decisional value in a bayesian program designed for secondary hypertension diagnosis. Six physicians, twice at one month intervals, assigned each patient to one of the three categories of risk (low, moderate, high). The order of cases was randomized. Chance corrected agreement (intra-physician agreement) between the two estimations was only moderate except for one expert (kappa values: 0.658, 0,543, 0.439, 0.363, 0.328 and 0.207 for each expert, respectively). The proportion of patients assigned by each physician to each category ranged from 22.7% to 77.3% for the low risk, and from 4.5% to 43.9% for the high risk category. One physician overestimated risk, one underestimated it and the three others were in keeping with framingham predictions. Bias and lack of reproducibility influence physician judgment in assessing cvd risk of hypertensive patients. Application of computer aids could result in more rational assessments and better decision making.