Cardiac late events in German breast cancer patients: a validation study on the agreement between patient self-reports and information from physicians

Abstract

BackgroundSelf-administered health-status questionnaires are important tools in epidemiology. The objective of the presented validation study is to measure the agreement between breast cancer patients’ self-reports and their physicians’ information on late cardiac events, and to investigate determinants of agreement. To estimate possible misclassification is an important requirement for observational studies on cardiovascular endpoints.MethodsA retrospective, multi-center cohort study included 11,982 women diagnosed with breast cancer in Germany in 1998–2008. In 2014, a questionnaire survey assessed cardiovascular risk factors and incident cardiac events after therapy. A validation study was conducted, based on a sample of 3091 breast cancer patients from two university hospitals. Among them, 2261 women (73%) sent back the questionnaire on cardiovascular events, and 1316 women gave consent to request medical records from their general practitioners. A total of 1212/1316 (92.1%) medical records could be obtained for validation. Cohen’s kappa coefficient was calculated, and multivariate regression was applied to study the influence of patient characteristics on agreement between both data sources.ResultsOverall agreement for the composite endpoint of any cardiac event was 84.5% (kappa 0.35). Of 1055 breast cancer patients reporting no cardiac event, 950 (90%) had no such diagnosis in physicians’ medical records. A total of 157 breast cancer survivors indicated a cardiac event, and the same diagnosis was confirmed by GPs for 74 (47%) women. For specific diagnoses, moderate to substantial agreement of self-reports was found for myocardial infarction (kappa 0.54) and stroke (kappa 0.61). Poor to fair agreement was present for angina pectoris, valvular heart disease, arrhythmia, and congestive heart failure. Younger age, higher education and a more recent cancer diagnosis were found to be associated with greater total agreement.ConclusionsFor the composite endpoint, survivors of breast cancer report the absence of cardiac disease accurately. However, for specific diagnoses, self-reported morbidity data from breast cancer patients may not fully agree with information from physicians. The agreement is moderate for acute events like myocardial infarction and stroke, but poor to fair for chronic diseases.Electronic supplementary materialThe online version of this article (10.1186/s12872-018-0961-7) contains supplementary material, which is available to authorized users.

Inaccurate recognition of own comorbidities is associated with poor prognosis in elderly patients with heart failure

“…This is the first study to report that the agreement between self-reported and provider-reported comorbidities among older hospitalized patients with heart failure is generally poor. Though a direct comparison was not performed, the agreements of hypertension, diabetes mellitus, COPD, and coronary artery disease were numerically lower in patients with heart failure compared with the general elderly population, [1][2][3] patients with cancer, [10][11][12] and patients with chronic kidney disease, 13,14 which may be due to a variety of reasons. As the FRAGILE-HF study focused on older patients with heart failure, the patient population in this study included older patients, and age is a strong predictor of disagreement between patient reports and medical records regarding the presence or absence of comorbidities.…”

“…As the FRAGILE-HF study focused on older patients with heart failure, the patient population in this study included older patients, and age is a strong predictor of disagreement between patient reports and medical records regarding the presence or absence of comorbidities. 9,11,12,28 However, the cohorts evaluated in some previous studies were the same age or older than the patients included in this study. [1][2][3] Therefore, heart failure itself might have contributed to the poor agreement observed in this study.…”

“…While 38% of the patients in this study had cognitive dysfunction, previous studies have either included very few patients with cognitive dysfunction, 2 excluded patients with cognitive dysfunction, 3 or did not report the presence or absence of cognitive dysfunction. 1,[8][9][10][11][12][13][14]28 The number of comorbidities may also be associated with disagreement. Patients with heart failure often have a high number of comorbidities.…”

“…5,6 The understanding and recognition of one's own comorbidities is an essential and fundamental aspect of patient education. 7 Studies on the general population, [1][2][3]8,9 patients with cancer, [10][11][12] and patients with chronic kidney disease 13,14 have reported that patients do not necessarily recognize their own comorbid conditions that are recorded in their medical records and that the agreement between self-reported and provider-reported comorbidities is generally poor. The accuracy of self-reported comorbidities among patients with heart failure has not been reported.…”

Cardiac late effects after modern 3D-conformal radiotherapy in breast cancer patients: a retrospective cohort study in Germany (ESCaRa)

“…Furthermore, self-reported events may be prone to information bias due to restrictions in memory, a lack of fully understanding medical diagnoses, or selective reporting [ 40 ]. However, a validation study revealed moderate to fair agreement between self-reported events compared with medical records from general practitioners [ 41 ].…”