Patient Perception Versus Medical Record Entry of Health-Related Conditions Among Patients With Heart Failure

Abstract

A shared understanding of medical conditions between patients and their health care providers may improve self-care and outcomes. In this study, the concordance between responses to a medical history self-report (MHSR) form and the corresponding provider documentation in electronic health records (EHRs) of 19 select co-morbidities and habits in 230 patients with heart failure were evaluated. Overall concordance was assessed using the κ statistic, and crude, positive, and negative agreement were determined for each condition. Concordance between MHSR and EHR varied widely for cardiovascular conditions (κ = 0.37 to 0.96), noncardiovascular conditions (κ = 0.06 to 1.00), and habits (κ = 0.26 to 0.69). Less than 80% crude agreement was seen for history of arrhythmias (72%), dyslipidemia (74%), and hypertension (79%) among cardiovascular conditions and lung disease (70%) and peripheral arterial disease (78%) for noncardiovascular conditions. Perfect agreement was observed for only 1 of the 19 conditions (human immunodeficiency virus status). Negative agreement >80% was more frequent than >80% positive agreement for a condition (15 of 19 [79%] vs 8 of 19 [42%], respectively, p = 0.02). Only 20% of patients had concordant MSHRs and EHRs for all 7 cardiovascular conditions; in 40% of patients, concordance was observed for ≤5 conditions. For noncardiovascular conditions, only 28% of MSHR-EHR pairs agreed for all 9 conditions; 37% agreed for ≤7 conditions. Cumulatively, 39% of the pairs matched for ≤15 of 19 conditions. In conclusion, there is significant variation in the perceptions of patients with heart failure compared to providers’ records of co-morbidities and habits. The root causes of this variation and its impact on outcomes need further study.

Hypertensive Patients: Self-Care Management Practices in Al-Taif, KSA

“…In contrast to our results, Lee et al, (2010) 47 found that older patients with hypertension had healthier self-care behavior. In the present study it was found that females had significantly higher self-management behavior score as compared to males (2.47±0.40 versus 2.08± 0.54).…”

“…Cognitive impairment leads to shortfalls in attention, learning, memory, executive functions, and psychomotor speed and may impair their ability to carry out self-care and adhere to treatment requirements. Such shortages may also compromise patients" capacity to recognize worsening symptoms and make proper decisions about their health care (Malik et al, 2011) 46 .…”

Cognitive function and left ventricular assist device implantation

“…19 These deficits can compromise the ability of HF patients to recognize and respond appropriately to worsening symptoms. 23 Studies have shown that HF patients with CI struggle more with medication management, are less likely to seek outpatient treatment, and fail to recognize worsening symptoms. [24][25][26] Additionally, two large multicenter studies indicated that CI is associated with a sixfold increase in functional disability in HF patients and a fivefold increase in mortality.…”

Reversible Motor Paralysis and Early Cardiac Rehabilitation in Patients With Advanced Heart Failure Receiving Left Ventricular Assist Device Therapy

“…9,10) Recently, cognitive dysfunction and motor impairment have been attracting concern as one of the end-organ dysfunctions due to advanced HF. [1][2][3][4][5] The precise mechanisms remain unclear, but microthrombosis due to decreased left ventricular contraction or reduced brain circulation may cause such an impaired brain function. [11][12][13] Our patient suffered left hemiplegia during hemodynamic deterioration without any imaging evidence of stroke.…”

“…[1][2][3][4][5] Improvement of such brain impairment is strongly expected after left ventricular assist device (LVAD) implantation because resocialization is encouraged in such LVAD patients. 6) However, little is known about the perioperative therapeutic strategy for brain impairment, particularly from the viewpoint of cardiac rehabilitation.…”