Abstract 14674: Under- or Over-Estimation of Patients’ Health Status by Physicians in the Care of Patients With Atrial Fibrillation

Abstract

Introduction: A primary objective of managing atrial fibrillation (AF) is to optimize patients’ health status (HS), symptoms, function, and quality of life, with an accurate assessment. However, the accuracy of physicians’ estimation of patients’ HS, and its impact on treatment decisions, remains unreported. Aims: To explore the discordance between physicians’ estimation and patients’ HS in those with newly-recognized AF and its association with subsequent care. Methods: From 2018-2020, newly diagnosed or referred AF patients at two outpatient practices in Tokyo completed the Atrial Fibrillation Effect on QualiTy of Life questionnaire (AFEQT, 20 items with a 7-point Likert scale). Blinded to patients’ AFEQT, treating physicians quantified patients’ HS using 3 items reflecting each AFEQT domain. Both physicians’ and patients’ raw responses were averaged, with higher scores indicating worse HS. We defined under-estimation as the physician reporting a score ≤-1 lower and over-estimation as a score ≥1 higher than the patient’s average. We examined the association of HS estimation with treatment and compared 1-year changes in AFEQT. Results: Among 330 patients with newly-recognized AF, physicians correctly estimated patients’ HS in 187 (56.7%), under-estimated its severity in 22 (6.7%), and over-estimated it in 121 (36.7%). Treatment escalation, defined as alteration or initiation of antiarrhythmic drugs, referral for cardioversion, or catheter ablation, occurred in 65.2%, 40.9%, and 61.9% of patients in the correctly, under-, and over-estimated groups, respectively. After adjusting for patient’s characteristics, under-estimation was independently associated with a lack of treatment escalation (adjusted OR 0.30, 95% CI 0.11-0.81) and with less improvement in the AFEQT Symptom scale at 1-year (-3.5 [SE 0.8] vs. 7.0 [SE 3.6] points in under- vs. correctly and over-estimated patients, P=.005) Conclusions: Under-recognition of AF patients’ HS is associated with less aggressive treatment and less health status improvement at 1 year. Standardized assessments of patients’ health status with validated questionnaires may help reduce under-and over-estimating patients’ HS, resulting in greater treatment appropriateness and better outcomes.