Abstract 7: Patient and Physician Discordance in Reporting Symptoms of Angina

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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.

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