预测心力衰竭的门诊患者的1年死亡率与减少左心室射出分数:经验模型是否优于医生的直觉估计? 一个多中心的队列研究
Ana C Alba1,2, Tayler A Buchan1,2, Sudipta Saha1
1Peter Munk Cardiac Centre, Ted Rogers Center for Heart Research, University Health Network, Toronto, ON, Canada (A.C.A., T.A.B., S.S., S.F., V.R., H.J.R.).
Circulation. Heart failure
|June 20, 2023
概括
医生高估了心力衰竭患者的死亡风险. 预测模型,如西雅图心力衰竭模型 (SHFM),在心力衰竭 (HF) 患者的1年死亡率预测方面提供了卓越的准确性.
科学领域:
- 心脏病学 心脏病学
- 医学预测 医学预测
- 医疗信息学 医疗信息学
背景情况:
- 医生预后估计的准确性经常受到争议.
- 在心力衰竭 (HF) 中,医生和基于模型的预测之间缺乏直接比较.
- 这项研究解决了需要比较医生与模型对HF1年死亡率的预测性表现.
研究的目的:
- 将医生预测的准确性与心力衰竭 (HF) 患者1年死亡率的既定模型进行比较.
- 评估医生和预测模型的歧视,校准和风险重新分类能力.
- 在HF管理中,为患者护理和资源配置的潜在改进提供信息.
主要方法:
- 一项多中心前性队列研究,涉及11家加拿大诊所的1643名外科医生,患有降低射出分数的HF.
- 用临床数据计算1年死亡率预测,使用西雅图高频率模型 (SHFM),高频率元得分和慢性高频率评分的全球群体元分析.
- 高频心脏病专家和家庭医生对模型输出失明,提供了独立的1年死亡率预测. 结果包括死亡率,紧急心室辅助装置植入或1年内心脏移植.
主要成果:
- 西雅图高频模型 (SHFM) 显示出最好的区分 (C-统计 0.76) 和校准.
- 医生表现出类似的歧视 (心脏病专家为0.75,家庭医生为0.73),但在低风险和高风险组中显著高估了风险 (>10%).
- SHFM显示出优异的风险重新分类,正确识别了更多没有事件的患者,并更准确地评估了与医生相比经历事件的患者的风险.
结论:
- 虽然医生证明了足够的风险歧视,但他们大大高估了绝对风险.
- 预测模型,特别是SHFM,在预测HF患者1年死亡率方面表现出更高的准确性.
- 将预测模型集成到临床实践中可能会提高患者护理,并优化HF管理中的资源利用.
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