Concordance between patient and physician reported symptoms in patients with heart failure and a LVEF equal to or less than 60%: a multinational survey in the EU

Abstract

Abstract Background and purpose Heart Failure (HF) is associated with symptoms such as dyspnoea and fatigue, however, physicians and patients' perception of HF symptoms may differ. This study aimed to explore the extent to which symptoms experienced by patients with HF are recognized by their physician and if physicians over- or under-reported HF symptoms. Methods A cross-sectional study of patients with HF was conducted in France, Germany, Italy, Spain and the United Kingdom (Disease Specific Programme in HF by Adelphi Real World). Patient record forms (PRFs) were completed by 257 cardiologists and 158 general practitioners (GPs) for consecutively consulting patients. The same patients were invited to complete a patient self-completion questionnaire (PSC). Only responses from PRFs with an associated PSC were analysed. Concordance was calculated as agreement between PSC and PRF when both were aligned with the presence or absence of HF symptom out of the total number of matched pairs. The over- or under-reporting of the occurrence of symptoms by the physicians relative to patient-reported symptoms was also calculated by taking the patient perspective and evaluating how often a patient-reported symptom was not recognized in the PRF (physician under-reporting) and vice versa (physician over-reporting). Results 792 HF patients with LVEF ≤60% (35% female) with a mean age of 68.6 years were included. 58% of PRFs were completed by cardiologists and 42% by GPs. The most common patient reported HF symptoms were dyspnoea when active (74%), fatigue (59%) and oedema (42%) (Figure 1a). Overall, a high concordance rate was observed in reporting of HF symptoms between patients and their physicians ranging between 75% for fatigue and 94% for gastric/intestinal discomfort (Figure 1b). In non-concordant cases, most symptoms were under-reported by physicians, except dyspnoea when active and fatigue/weakness which were over-reported in 34/33%, respectively. The frequency of over-reporting of HF symptoms by the physicians was higher for more frequently patient reported symptoms while under-reporting was observed in less frequently reported symptoms such as gastric/intestinal discomfort, swelling of abdomen, inability to sleep, paroxysmal nocturnal dyspnoea and orthopnoea (Figure 1c). Conclusions The current study suggests that there is an overall high concordance between physicians and patients in reporting HF symptoms. However, while physicians were aware of the most prevalent HF symptoms experienced by patients, it was more common to under-report the less frequent HF symptoms. Ensuring patient education and good communication between patients and their physicians might help better and earlier identification of HF symptoms. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis Pharma AG