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

Abstract

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.