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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
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: b.j.mulder@amc.uva.nl

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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2011

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