Abstract 7: Patient and Physician Discordance in Reporting Symptoms of Angina: Insights from the Angina Prevalence and Provider Evaluation of Angina Relief (APPEAR) Study

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Ali Shafiq ◽  
Faraz Kureshi ◽  
Suzanne V Arnold ◽  
Kensey Gosch ◽  
Tracie Breeding ◽  
...  
Keyword(s):  
Clinical Care ◽  
Stable Coronary Artery Disease ◽  
Kappa Statistic ◽  
Cross Sectional Study ◽  
Kappa Statistics ◽  
Cross Sectional ◽  
Patient Reported ◽  
Angina Frequency ◽  
Artery Disease ◽  
Stable Cad

Background: Eradication/minimization of angina is a primary therapeutic goal in the management of stable coronary artery disease (CAD). However, eliciting the presence/frequency of patients’ angina can be challenging, particularly in a busy outpatient clinic. We independently measured and compared patients’ and physicians’ assessments of the frequency of angina in US outpatient cardiology practices. Methods: From the ACC NCDR PINNACLE registry, we identified 23 practices and conducted a cross-sectional study of patients with stable CAD. Using the SAQ Angina Frequency (AF) scale, patients’ angina was categorized as daily/weekly (SAQ AF Score <60), monthly (SAQ AF Score=60-99) and none (SAQ AF Score=100). Kappa statistics were used to assess agreement between physicians’ and patients’ reported angina. Results: Among 1153 outpatients with stable CAD from 23 cardiology clinics, 8% reported daily/weekly, 24% monthly and 68% no angina. When patients reported daily/weekly, monthly or no angina symptoms, physicians agreed 70%, 16% and 94% of the time respectively, with physicians reporting no angina a quarter of the time in patients with weekly or greater angina (Figure). Agreement between patients and physician reports, as determined with a Kappa Statistic, was 0.41 (95% CI=0.36, 0.44) Conclusion: There was discordance between patient and physician reports of angina, especially among patients who reported having infrequent angina over the past 4 weeks. Moreover, physicians reported no angina among 1 of 4 patients having daily/weekly symptoms. Improving the communication between patients and physicians about the presence of angina may improve patients’ treatment and outcomes. These results support recent proposals to include patient-reported outcomes measures in routine clinical care, which may support better recognition, by physicians, of patients’ symptoms and improve treatment.

Abstract 085: Discordance in Patient-Physician Perceptions of Angina Experiences and Delivery of Care

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Suzanne V Arnold ◽  
Prakash C Deedwania ◽  
Cherilyn Heggen-Peay ◽  
Laurence Greene ◽  
Jeffrey D Carter ◽  
...  
Keyword(s):  
Improve Patient Care ◽  
Poor Quality ◽  
Assessment Tools ◽  
Delivery Of Care ◽  
Physician Perceptions ◽  
Patient Reported ◽  
Angina Frequency ◽  
Artery Disease ◽  
Stable Cad ◽  
The Impact

Background: Recent findings from the APPEAR study indicate that physicians under-recognize angina frequency in many patients with coronary artery disease (CAD). We surveyed patients with angina and the physicians who treat them to further explore factors that may contribute to under-recognition and the impact of under-recognition on patients’ experiences. Methods: Surveys were completed by 29 US physicians and 122 of their patients with stable CAD. Patients reported burden of angina and satisfaction with medication. Physicians estimated the average experience of their patients with stable CAD. Results: As with prior studies, physicians under-estimated burden of angina as reported by the patients (physician vs. patient report: weekly of more angina: 24% vs 50%, p=0.014; CCS III/IV: 22% vs 43%, p<0.001). Physicians also over-estimated patients’ satisfaction with control of their angina (70% vs 50%, p<0.001). Over 90% of physicians reported routinely asking patients about the frequency of their angina and adherence to antianginal medications (Figure). Most physicians estimate angina using NYHA or CCS class (59% and 24%, respectively) whereas 7% used a patient-reported assessment. While lack of time was reported as the biggest barrier to accurately assessing patients’ burden of angina, most physicians reported having no challenges to conducting these assessments. Conversely, 68% of patients reported that their physicians effectively communicated with them. Conclusions: Using a detailed survey of patients with stable CAD and their physicians, we found that physicians believe they are communicating effectively and most patients agreed (although to a lesser degree); yet, a substantial discordance between physician and patient perceptions of angina remains. These discordances may contribute to suboptimal treatment decisions, decreased treatment satisfaction, and poor quality of life. The observed discordances may be explained partly by the fact that <10% of physicians reported using a tool to assess angina burden directly from the patients, as physicians appeared to over-estimate their ability to accurately assess angina using traditional interview techniques. Education and use of validated angina assessment tools are essential for aligning perceptions to improve patient care and outcomes.

Abstract 275: Interleukins 17th and 22th in Stable Coronary Artery Disease

2013 ◽  
Vol 113 (suppl_1) ◽  
Author(s):  
Dinaldo Oliveira ◽  
Maira R Pitta ◽  
Ivan R Pitta ◽  
Elayne Heide ◽  
Viviane R Gomes ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Analytical Study ◽  
Stable Coronary Artery Disease ◽  
Myocardial Revascularization ◽  
Myocardial Scintigraphy ◽  
Cross Sectional ◽  
Artery Disease ◽  
Stable Cad

Introduction: The role of the immune and inflammatory pathways in coronary artery disease (CAD) is important but not complete understood. The aim of this study was to evaluate expressions of the interleukins 17th and 22th in patients with stable coronary artery disease. Hypothesis: Interleukins 17th and 22th are not increased in stable CAD. Methods: This is a cross-sectional, prospective, analytical study, conducted from August to December 2012. We included 40 patients (P) with stable CAD, CCS III or IV, ischemic myocardial scintigraphy, who had not been subjected to any kind of myocardial revascularization and with coronary stenosis equal or major than 50% according to current coronary angiography. There were 20 healthy volunteers (C), to take up comparison of expression of interleukins (IL). We evaluated the levels of IL 17th and 22th of the patients and controls. Interleukins were evaluated in serum of patients and after 48 hours of cells in culture with and without stimulus. IL concentrations were expressed in pg / ml. Statistical analysis was performed using the Mann-Whitney or Student t test. P ≤ 0,05 was considered statistically significant. Results: There were 26 men and 14 women in the group of the patients and 12 men and 8 women in the controls. The age was similar between the groups (63.2 ± 8.9 years vs 57.9 ± 9.4, p = ns). The comparison between the groups showed: Interleukin 17th: Serum: P = 3.9 (972.2 -- 2.93) vs C = 3.90 (28.8 -- 1.74), p = 0.5; culture 48 hours without stimulus: P = 3.90 (3.90 -- 3.90) vs C = 6.37 (3.90 - 11), p = 0.8; culture 48 hours with stimulus: P = 302.42 (2200 -- 3.90) vs C = 815 (1353 -- 3.90), p = 0.06. Interleukin 22th: Serum: P = 15.62 (64.72 -- 15.62) vs C = 15.62 (121 -- 15.62), p = 0.2; Culture 48 hours without stimulus: P = 11 (128.93 -- 7.81) vs C = 7.81 (7.81 -- 7.81), P = 0.8; Culture 48 hours with stimulus: P = 135 (2486.7 -- 7, 81) vs C = 322.86 (1319.11 -- 7.81), p = 0.4. Conclusions: There were no differences in concentrations of interleukins, but the trend of higher expression of the IL 17th in the controls after cell culture with stimulus. In conclusion, in patients with stable CAD the interleukins 17th and 22th did not exhibit increased concentrations.

scholarly journals Pericoronary adipose tissue computed tomography attenuation distinguishes different stages of coronary artery disease: a cross-sectional study

2020 ◽  
Author(s):  
Andrew Lin ◽  
Nitesh Nerlekar ◽  
Jeremy Yuvaraj ◽  
Katrina Fernandes ◽  
Cathy Jiang ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Coronary Artery ◽  
Cross Sectional Study ◽  
Imaging Biomarker ◽  
Plaque Burden ◽  
Sectional Study ◽  
Cross Sectional ◽  
Ct Attenuation ◽  
Artery Disease ◽  
Stable Cad

Abstract Aims  Vascular inflammation inhibits local adipogenesis in pericoronary adipose tissue (PCAT) and this can be detected on coronary computed tomography angiography (CCTA) as an increase in CT attenuation of PCAT surrounding the proximal right coronary artery (RCA). In this cross-sectional study, we assessed the utility of PCAT CT attenuation as an imaging biomarker of coronary inflammation in distinguishing different stages of coronary artery disease (CAD). Methods and results Sixty patients with acute myocardial infarction (MI) were prospectively recruited to undergo CCTA within 48 h of admission, prior to invasive angiography. These participants were matched to patients with stable CAD (n = 60) and controls with no CAD (n = 60) by age, gender, BMI, risk factors, medications, and CT tube voltage. PCAT attenuation around the proximal RCA was quantified per-patient using semi-automated software. Patients with MI had a higher PCAT attenuation (−82.3 ± 5.5 HU) compared with patients with stable CAD (−90.6 ± 5.7 HU, P &lt; 0.001) and controls (−95.8 ± 6.2 HU, P &lt; 0.001). PCAT attenuation was significantly increased in stable CAD patients over controls (P = 0.01). The association of PCAT attenuation with stage of CAD was independent of age, gender, cardiovascular risk factors, epicardial adipose tissue volume, and CCTA-derived quantitative plaque burden. No interaction was observed for clinical presentation (MI vs. stable CAD) and plaque burden on PCAT attenuation. Conclusion PCAT CT attenuation as a quantitative measure of global coronary inflammation independently distinguishes patients with MI vs. stable CAD vs. no CAD. Future studies should assess whether this imaging biomarker can track patient responses to therapies in different stages of CAD.

Periodontitis and tooth loss have negative impact on dietary intake: A cross‐sectional study with stable coronary artery disease patients

2019 ◽  
Vol 90 (10) ◽  
pp. 1096-1105 ◽  
Author(s):  
Dayana D. Mendonça ◽  
Mariana V. Furtado ◽  
Roberta A. Sarmento ◽  
Bruna B. Nicoletto ◽  
Gabriela C. Souza ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Dietary Intake ◽  
Tooth Loss ◽  
Negative Impact ◽  
Stable Coronary Artery Disease ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Artery Disease

Review of the Bethesda System for Reporting Thyroid Cytopathology: A Local Study in Bohol Island, Philippines

2015 ◽  
Vol 59 (1) ◽  
pp. 77-82 ◽  
Author(s):  
Annette L. Salillas ◽  
Faye Candice S. Sun ◽  
Emelisa G. Almocera
Keyword(s):  
Kappa Statistic ◽  
Needle Aspiration ◽  
Cross Sectional Study ◽  
Kappa Statistics ◽  
Cross Sectional ◽  
Local Study ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
Thyroid Cytopathology ◽  
The Bethesda System

Objectives: The aim of this study was to evaluate the adaptability and reproducibility of the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) in a local setting and to determine the risk of malignancy for each category. Materials and Methods: A retrospective cross-sectional study of 80 thyroid fine-needle aspiration cytology cases using the BSRTC with corresponding histopathology was done between September 2009 and December 2012. Agreement scores were calculated using kappa statistics. Results: Consensus among two readers was attained for 73 cases (91.25%). No disagreement was noted for the malignant cases. The strength of agreement was very good, with a kappa statistic of 0.90. The risk of malignancy observed histologically was as follows: benign 3%, atypia of undetermined significance (AUS) 50%, suspicious for follicular/Hürthle cell neoplasm 50%, suspicious for malignancy 78%, and malignant 100%. Conclusion: In this study, there is an outstanding reproducibility for the classification scheme. The application of the BSRTC as the standardized reporting is readily adaptable and therefore its application in larger medical centers is highly recommended. Our findings of a higher risk of malignancy seen in AUS (50%) and malignant (100%) categories in those who underwent surgical resection corroborated other published studies. Conveying this risk to clinical colleagues is important and will facilitate optimal patient care.

Abstract 18360: Predictors of Physician Under-recognition of Angina in Outpatients With Stable Coronary Artery Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Anna Grodzinsky ◽  
Mikhail Kosiborod ◽  
John Beltrame ◽  
Kensey Gosch ◽  
Philip G Jones ◽  
...  
Keyword(s):  
Stable Coronary Artery Disease ◽  
Clinic Visit ◽  
Physician Characteristics ◽  
Standard Patient ◽  
Patients With Heart Failure ◽  
Angina Frequency ◽  
Random Site ◽  
Artery Disease ◽  
Stable Cad

Background: Under-recognition of angina by physicians may result in under-treatment with revascularization or medications that could improve patients’ quality of life. Patient and physician characteristics associated with under-recognition have never been described. Methods: Outpatients with stable CAD in a 24-site US registry completed the Seattle Angina Questionnaire (SAQ) and their physicians independently quantified patients’ angina in the month prior to their clinic visit. Angina frequency was categorized as none, monthly, and daily/weekly. Among patients who reported angina, under-recognition was defined as the physician reporting a lower frequency of angina than the patient. A hierarchical (for site and physician) logistic model examined patient and physician factors associated with under-recognition of angina. Physician variability was assessed with a median odds ratio (MOR), which compares the likelihood of 1 physician at 1 random site under-recognizing angina vs. another physician at another site. Results: Among 1203 patients with stable CAD, 304 patients reported angina in the prior month, of whom 122 (40%) were under-recognized by their physician. Physicians were more likely to under-recognize the frequency of angina in patients with heart failure and among patients with less frequent angina (Figure). No other patient or physician factors were associated with under-recognition. There was significant variability across physicians (MOR 2.6), indicating that some physicians were better than others at recognizing angina. Conclusions: Under-recognition of angina is common in routine clinical practice and was largely unrelated to standard patient and physician characteristics. The large variation across physicians suggests that a more systematic approach is needed to assess angina from patients with CAD. The use of a validated tool, such as the SAQ, should be tested for improving angina recognition and outcomes.

Sign in / Sign up

Export Citation Format

Share Document