Patient and physician discordance in reporting symptoms of angina among stable coronary artery disease patients: Insights from the Angina Prevalence and Provider Evaluation of Angina Relief (APPEAR) study

Am Heart J. 2016 May;175:94-100. doi: 10.1016/j.ahj.2016.02.015. Epub 2016 Feb 27.


Background: A principal goal of treating patients with coronary artery disease (CAD) is to minimize angina and optimize quality of life. For this, physicians must accurately assess presence and frequency of patients' angina. The accuracy with which cardiologists estimate their patients' angina in contemporary, busy outpatient clinics across the United States (US) is unknown.

Methods: We enrolled patients with CAD across 25 US cardiology outpatient practices. Patients completed the Seattle Angina Questionnaire before their visit, which assessed their angina and quality of life over the prior 4 weeks. The Seattle Angina Questionnaire angina frequency domain categorized patients' angina as none, daily/weekly, or monthly. After the visit, cardiologists estimated the frequency of their patients' angina using the same categories. Kappa statistic helped to assess agreement between patient-reported and cardiologist-estimated angina.

Results: Among 1,257 outpatients with CAD, 67% reported no angina, 25% reported monthly angina, and 8% reported daily/weekly angina. When patients reported no angina, cardiologists accurately estimated this 93% of the time, but when patients reported monthly or daily/weekly angina symptoms, cardiologists agreed 17% and 69% of the time, respectively. Among patients with daily/weekly angina, 26% were noted as having no angina by their physicians. Agreement between patients' and cardiologists' reports (assessed by the kappa statistic) was 0.48 (95% CI 0.44-0.53), indicating moderate agreement.

Conclusions: Among outpatients with stable CAD, there is substantial discordance between patient-reported and cardiologist-estimated burden of angina. Inclusion of patient-reported health status measures in routine clinical care may support better recognition of patients' symptoms by physicians.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Angina, Stable* / diagnosis
  • Angina, Stable* / epidemiology
  • Angina, Stable* / psychology
  • Australia / epidemiology
  • Diagnostic Self Evaluation*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Quality of Life*
  • Statistics as Topic
  • Surveys and Questionnaires
  • Symptom Assessment / methods*