Physician Prediction versus Model Predicted Prognosis in Ambulatory Patients with Heart Failure

Abstract

Purpose Previous evidence suggests that both cardiologists and family doctors have limited accuracy in predicting patient prognosis. Predictive models with satisfactory accuracy for estimating mortality in heart failure (HF) patients exist; physicians, however, seldom use these models. We evaluated the relative accuracy of physician versus model prediction to estimate 1-year survival in ambulatory HF patients. Methods We conducted a single centre prospective cohort study involving 150 consecutive ambulatory HF patients >18 years of age with a left ventricular ejection fraction ≤40%. Each patient's cardiologist and family doctor provided their predicted 1-year survival. Using clinical and laboratory data at the time of enrolment we calculated predicted survival using three models: the HF Meta-Score, the Seattle Heart Failure Model (SHFM) and the Meta-Analysis Global Group in Chronic HF (MAGGIC) score. We compared accuracy between physician and model predictions using intra-class correlation (ICC). Results Median predicted survival by HF cardiologists was lower (median 80%, IQR 61-90%) than that predicted by family doctors (median 90%, IQR 70-99%, p=0.08). The 1-year median predicted survivals calculated by the HF Meta-Score (94.6%), SHFM (95.4%) and MAGGIC (88.9%,) proved as high or higher than physician estimates. Agreement among both HF cardiologists (ICC 0.28-0.41) and family doctors (ICC 0.43-0.47) when compared to 1-year model-predicted survival scores proved limited, while the 3 models agreed well with one another (ICC >0.65). Conclusion We found that median survival estimates are lower among HF cardiologists in comparison to family doctors, while both physician estimates are lower than calculated model estimates. Considering previous evidence that model's accuracy is acceptable and physicians’ is limited, our results provide additional evidence of the superior accuracy of predictive models 1-year survival in ambulatory HF patients. These results should be validated in longitudinal studies collecting actual survival.