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New York Heart Association class assessment by cardiologists and outpatients with congenital cardiac disease: a head-to-head comparison of three patient-based versions

Published online by Cambridge University Press:  04 July 2011

Dounya Schoormans ,
Yuma L. Mager ,
Frans J. Oort ,
Mirjam A.G. Sprangers  and
Barbara J.M. Mulder
Dounya Schoormans
Affiliation:
Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
Yuma L. Mager
Affiliation:
Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
Frans J. Oort
Affiliation:
Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
Mirjam A.G. Sprangers
Affiliation:
Department of Medical Psychology, Academic Medical Centre, Amsterdam, The Netherlands
Barbara J.M. Mulder*
Affiliation:
Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
*
Correspondence to: Dr B. J. M. Mulder, MD, PhD, FESC, Academic Medical Centre, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands. Tel: +31(0)205662193; Fax: +31(0)205666809; E-mail: [email protected]
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Abstract

Background

The objective of this study was to compare three patient-based New York Heart Association assessments with cardiologist assessments in outpatients with congenital cardiac disease.

Methods

Consecutive adult outpatients completed three questionnaires in a random order: a patient-based translation of the New York Heart Association classes, a self-constructed questionnaire based on the New York Heart Association classes, and the Specific Activity Scale. The treating cardiologist assessed the New York Heart Association class on the same day. Patient–cardiologist agreement was assessed by calculating percent agreement and weighted kappa. We also explored the level of agreement for patients without co-morbidity.

Results

In all, 86 adults – with a median age of 35.8 years – including 46 women participated. An agreement of 75.6% (weighted kappa is 0.43; probability is smaller than 0.01), 70.6% (weighted kappa is 0.44; probability is smaller than 0.01), and 74.4% (weighted kappa is 0.28; probability is smaller than 0.01) was found between the cardiologist assessment and the patient-based translation, self-constructed questionnaire, and the Specific Activity Scale, respectively. The patient-based translation equally over- and underestimated the New York Heart Association class, whereas the self-constructed questionnaire overestimated and the Specific Activity Scale underestimated the New York Heart Association class. Agreement levels for patients without co-morbidity were higher than agreement levels for the total group.

Conclusion

The patient-based translation yielded adequate agreement with cardiologist-assessed New York Heart Association class, showed equal over- and underestimation, and was easy to complete. The patient-based translation with the instruction to only consider functional impairments caused by the congenital cardiac defect is recommended in future studies of outpatients with congenital cardiac disease.

Keywords

Congenital cardiac defectfunctional statuspatient–cardiologist agreement
Type
Original Articles
Information
Cardiology in the Young , Volume 22 , Issue 1 , February 2012 , pp. 26 - 33
Copyright
Copyright © Cambridge University Press 2011

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References

1. Samanek, M. Congenital heart malformations: prevalence, severity, survival, and quality of life. Cardiol Young 2000; 10: 179–185.Google Scholar
2. Kamphuis, M, Zwinderman, KH, Vogels, T, et al. A cardiac-specific health-related quality of life module for young adults with congenital heart disease: development and validation. Qual Life Res 2004; 13: 735–745.CrossRefGoogle ScholarPubMed
3. Kamphuis, M, Ottenkamp, J, Vliegen, HW, et al. Health related quality of life and health status in adult survivors with previously operated complex congenital heart disease. Heart 2002; 87: 356–362.Google Scholar
4. Lane, DA, Lip, GY, Millane, TA. Quality of life in adults with congenital heart disease. Heart 2002; 88: 71–75.Google Scholar
5. Bennett, JA, Riegel, B, Bittner, V, Nichols, J. Validity and reliability of the NYHA classes for measuring research outcomes in patients with cardiac disease. Heart Lung 2002; 31: 262–270.Google Scholar
6. Dimopoulos, K, Diller, GP, Koltsida, E, et al. Prevalence, predictors, and prognostic value of renal dysfunction in adults with congenital heart disease. Circulation 2008; 117: 2320–2328.CrossRefGoogle ScholarPubMed
7. Moons, P, Van, DK, De, GS, Gewillig, M, Budts, W. Is the severity of congenital heart disease associated with the quality of life and perceived health of adult patients? Heart 2005; 91: 1193–1198.Google Scholar
8. Ekman, I, Kjork, E, Andersson, B. Self-assessed symptoms in chronic heart failure – important information for clinical management. Eur J Heart Fail 2007; 9: 424–428.Google Scholar
9. Goode, KM, Nabb, S, Cleland, JG, Clark, AL. A comparison of patient and physician-rated New York Heart Association class in a community-based heart failure clinic. J Card Fail 2008; 14: 379–387.Google Scholar
10. Kubo, SH, Schulman, S, Starling, RC, Jessup, M, Wentworth, D, Burkhoff, D. Development and validation of a patient questionnaire to determine New York Heart Association classification. J Card Fail 2004; 10: 228–235.CrossRefGoogle ScholarPubMed
11. Subramanian, U, Weiner, M, Gradus-Pizlo, I, Wu, J, Tu, W, Murray, MD. Patient perception and provider assessment of severity of heart failure as predictors of hospitalization. Heart Lung 2005; 34: 89–98.Google Scholar
12. van der Velde, ET, Vriend, JW, Mannens, MM, Uiterwaal, CS, Brand, R, Mulder, BJ. CONCOR, an initiative towards a national registry and DNA-bank of patients with congenital heart disease in the Netherlands: rationale, design, and first results. Eur J Epidemiol 2005; 20: 549–557.Google Scholar
13. Goldman, L, Hashimoto, B, Cook, EF, Loscalzo, A. Comparative reproducibility and validity of systems for assessing cardiovascular functional class: advantages of a new specific activity scale. Circulation 1981; 64: 1227–1234.CrossRefGoogle ScholarPubMed
14. Cohen, J. Set correlations and contiguency tables. Appl Psychol Meas 1988; 12: 425–434.CrossRefGoogle Scholar
15. Cohen, J. Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 1968; 70: 213–220.Google Scholar
16. Landis, JR, Koch, GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–174.Google Scholar
17. How can I calculate a kappa statistic for variables with unequal score ranges? from http://www.ats.ucla.edu/stat/spss/faq/kappa.htm (accessed on 8 March 2011).Google Scholar
18. Byrt, T, Bishop, J, Carlin, JB. Bias, prevalence and kappa. J Clin Epidemiol 1993; 46: 423–429.Google Scholar