Symptom Under-Recognition of Atrial Fibrillation Patients in Consideration for Catheter Ablation

Katsumata, Yoshinori; Kohsaka, Shun; Ikemura, Nobuhiro; Ueda, Ikuko; Hashimoto, Kenji; Yamashita, Tadamichi; Miyama, Hiroshi; Fujisawa, Taishi; Kimura, Tokuhiro; Tanimoto, Kojiro; Momiyama, Yukihiko; Suzuki, Masahiro; Fukuda, Keiichi; Takatsuki, Seiji

doi:10.1016/j.jacep.2020.10.016

Cited by 6 publications

(5 citation statements)

References 29 publications

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“…Recognizing the severity of patients’ health status can be challenging due to variability in history taking and time constraints faced by both patients and physicians. In prior work, 27% of patients with impaired health status due to AF were labeled as asymptomatic by physicians in their medical records, resulting in a lower likelihood of patients undergoing catheter ablation therapy . This study also revealed a high rate of overestimation of symptoms, with 45% of patients reporting no health status impairments, but being labeled as having symptomatic AF in their medical records.…”

Section: Introductionmentioning

confidence: 61%

“…In prior work, 27% of patients with impaired health status due to AF were labeled as asymptomatic by physicians in their medical records, resulting in a lower likelihood of patients undergoing catheter ablation therapy. 5,6 This study also revealed a high rate of overestimation of symptoms, with 45% of patients reporting no health status impairments, but being labeled as having symptomatic AF in their medical records. While the high prevalence of underestimation and overestimation of AF-related health status is concerning, a major limitation of this previous report was the use of dichotomized physician assessments of symptoms based on medical records, thereby oversimplifying physicians' estimates of patients' symptoms and potentially introducing misclassification.…”

Section: Introductionmentioning

confidence: 70%

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Physician Estimates and Patient-Reported Health Status in Atrial Fibrillation

Ikemura,

Kohsaka,

Kimura

et al. 2024

JAMA Netw Open

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ImportanceA primary objective in managing atrial fibrillation (AF) is to optimize patients’ health status, which can be done only if physicians accurately quantify the outcomes associated with AF in patients’ lives.ObjectiveTo explore physicians’ estimation of the health status of patients with AF and its association with subsequent care and outcomes.Design, Setting, and ParticipantsA multicenter, prospective cohort study was conducted in 2 outpatient practices in Tokyo, Japan. Participants included patients with newly diagnosed AF or those referred for initial treatment of AF at outpatient practices and treating physicians from November 8, 2018, to April 1, 2020. Data analysis was performed from December 22, 2022, to July 7, 2023.ExposuresParticipating patients completed the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire, a 20-item tool covering 4 domains with a 7-point Likert scale; 3 domains (symptoms, daily activities, and treatment concerns) were used in this study. Blinded to patients’ responses, treating physicians answered a 3-item questionnaire quantifying each patient’s AFEQT domain with a single item. Patients’ mean Likert scale responses within each AFEQT domain were subtracted from the physicians’ assessments so that higher scores (≥0.5 points) indicate physician underestimation, while lower scores (≤0.5 points) indicate physician overestimation of the health status of patients with AF.Main Outcomes and MeasuresThe independent association of physician-patient concordance with treatment escalation (alteration or initiation of antiarrhythmic drugs, cardioversion, or catheter ablation) and 1-year adjusted changes in AFEQT scores.ResultsAmong 330 patients (238 [72.1%] men; mean [SD] age, 67.9 [11.9] years; 163 [49.4%] with paroxysmal AF), physicians correctly estimated health status in 112 patients (33.9%), underestimated it in 42 patients (12.7%), and overestimated it in 176 patients (53.3%). Treatment escalation occurred in 63.6% of patients whose health status was correctly estimated, 47.6% of those whose health status was underestimated, and 66.3% of patients whose health status was overestimated. After multivariable adjustment, underestimation of health status was independently associated with less treatment escalation (adjusted odds ratio, 0.43; 95% CI, 0.20-0.90) and less frequent AFEQT overall summary score improvement at 1 year (underestimated, 2.5 [95% CI, −1.6 to 6.7] vs correctly and overestimated health status, 8.4 [95% CI, 7.0-9.9] points; P = .01).Conclusions and RelevanceIn this cohort study, physician underestimation of the health status of patients with AF was common and associated with less aggressive treatment and less health status improvement at 1 year.

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Section: Introductionmentioning

confidence: 61%

Section: Introductionmentioning

confidence: 70%

Physician Estimates and Patient-Reported Health Status in Atrial Fibrillation

Ikemura,

Kohsaka,

Kimura

et al. 2024

JAMA Netw Open

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“…While prior work suggests that patient-reported and EHR-documented symptoms may not always be concordant, 6 26 among patients with AF concordance is higher 7 potentially due to systematic interrogation and symptoms being a primary indication for ablation. One way to improve concordance both for rhythm and symptom reports is through the use of mobile apps to integrate patient generated-data into the EHR.…”

Section: Discussionmentioning

confidence: 89%

“…Whereas EHRs have certain known data quality and missingness issues they provide information on large samples of patients when patient self-reported data may be infeasible to collect at scale and inhibited by high attrition. 10 While prior work suggests that patient-reported and EHR-documented symptoms may not always be concordant, 6 26 among patients with AF concordance is higher 7 potentially due to systematic interrogation and symptoms being a primary indication for ablation. One way to improve concordance both for rhythm and symptom reports is through the use of mobile apps to integrate patient generated-data into the EHR.…”

Section: Discussionmentioning

confidence: 99%

Characterising symptom clusters in patients with atrial fibrillation undergoing catheter ablation

et al. 2023

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ObjectiveThis study aims to leverage natural language processing (NLP) and machine learning clustering analyses to (1) identify co-occurring symptoms of patients undergoing catheter ablation for atrial fibrillation (AF) and (2) describe clinical and sociodemographic correlates of symptom clusters.MethodsWe conducted a cross-sectional retrospective analysis using electronic health records data. Adults who underwent AF ablation between 2010 and 2020 were included. Demographic, comorbidity and medication information was extracted using structured queries. Ten AF symptoms were extracted from unstructured clinical notes (n=13 416) using a validated NLP pipeline (F-score=0.81). We used the unsupervised machine learning approach known as Ward’s hierarchical agglomerative clustering to characterise and identify subgroups of patients representing different clusters. Fisher’s exact tests were used to investigate subgroup differences based on age, gender, race and heart failure (HF) status.ResultsA total of 1293 patients were included in our analysis (mean age 65.5 years, 35.2% female, 58% white). The most frequently documented symptoms were dyspnoea (64%), oedema (62%) and palpitations (57%). We identified six symptom clusters: generally symptomatic, dyspnoea and oedema, chest pain, anxiety, fatigue and palpitations, and asymptomatic (reference). The asymptomatic cluster had a significantly higher prevalence of male, white and comorbid HF patients.ConclusionsWe applied NLP and machine learning to a large dataset to identify symptom clusters, which may signify latent biological underpinnings of symptom experiences and generate implications for clinical care. AF patients’ symptom experiences vary widely. Given prior work showing that AF symptoms predict adverse outcomes, future work should investigate associations between symptom clusters and postablation outcomes.

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“…has been stated that treatment opportunities, specifically atrial fibrillation ablation, have been missed as the presence of symptoms are an indication for an ablation procedure. 1 There is a statement in an accompanying editorial that, "This carefully conducted study of course provides as many questions as answers." 6 The editorial nicely discusses the difficulties in obtaining accurate histories from patients and that under-and over-recognition of symptoms frequently occur.…”

Section: Article In Pressmentioning

confidence: 99%