影响医生预后准确度的因素 心力衰竭 患有左心室排气分数减少的患者
Ana C Alba1, Tayler A Buchan1, Sudipta Saha2
1Peter Munk Cardiac Centre, Ted Rogers Center for Heart Research, University Health Network, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
JACC. Heart failure
|March 29, 2024
概括
与模型相比,医生对心力衰竭 (HF) 患者死亡率的预测往往是不准确的,特别是在高风险病例中. 即使是自信的医生估计,在预测HF患者的结果方面也显示出不理想的表现.
科学领域:
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
- 医疗决策的制定 医疗决策的制定
背景情况:
- 医生在预测心力衰竭 (HF) 门诊患者的死亡率方面的准确性是不理想的,表现不如预测模型.
- 之前的研究强调,需要了解影响医生预后准确性的因素.
研究的目的:
- 评估与心力衰竭 (HF) 门诊患者医生死亡率预测的准确性相关的患者和医生特定因素.
- 将医生预测与经过验证的模型 (西雅图HF模型) 进行比较.
主要方法:
- 来自11家诊所的HF门诊患者提供医生 (HF心脏病专家,家庭医生) 和基于模型的1年死亡率预测.
- 患者的死亡率被追踪了1年,包括死亡率相当的事件 (紧急心脏移植/VAD植入物).
- 多变量逻辑回归分析了医生/患者因子之间的关联以及与模型的预测一致性.
主要成果:
- 在1643名患者中,1年事件率为10%;50%的医生预测与模型预测不一致,通常是由于医生高估了风险.
- 差异随着患者的风险水平增加 (38%的低风险到~75%的高风险).
- 女性HF心脏病学家在预测男性患者死亡率方面显示出更多的差异; HF心脏病学家的预测对黑人患者来说更不一致. 低信心与差异有关.
结论:
- 医生和模型对HF患者死亡率的预测之间的差异很常见,特别是在高风险患者中.
- 预测模型超过了医生的判断力,即使医生表达了高度的信心.
- 医生过度估计风险是预测差异的关键驱动因素.
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