Factors Impacting Physician Prognostic Accuracy in Heart Failure Patients With Reduced Left Ventricular Ejection Fraction

BACKGROUND A recent study showed that the accuracy of heart failure (HF) cardiologists and family doctors to predict mortality in outpatients with HF proved suboptimal, performing less well than models. OBJECTIVES The authors sought to evaluate patient and physician factors associated with physician accuracy. METHODS The authors included outpatients with HF from 11 HF clinics. Family doctors and HF cardiologists estimated patient 1 -year mortality. They calculated predicted mortality using the Seattle HF Model and followed patients for 1 year to record mortality (or urgent heart transplant or ventricular assist device implant as mortality -equivalent events). Using multivariable logistic regression, the authors evaluated associations among physician experience and con fidence in estimates, duration of patient -physician relationship, patient -physician sex concordance, patient race, and predicted risk, with concordant results between physician and model predictions. RESULTS Among 1,643 patients, 1 -year event rate was 10% (95% CI: 8%-12%). One-half of the estimates showed discrepant results between model and physician predictions, mainly owing to physician risk overestimation. Discrepancies were more frequent with increasing patient risk from 38% in low -risk to w75% in high -risk patients. When making predictions on male patients, female HF cardiologists were 26% more likely to have discrepant predictions (OR: 0.74; 95% CI: 0.58-0.94). HF cardiologist estimates in Black patients were 33% more likely to be discrepant (OR: 0.67; 95% CI: 0.45-0.99). Low con fidence in predictions was associated with discrepancy. Analyses restricted to highcon fidence estimates showed inferior calibration to the model, with risk overestimation across risk groups. CONCLUSIONS Discrepant physician and model predictions were more frequent in cases with perceived increased risk. Model predictions outperform physicians even when they are con fident in their predictions. (Predicted Prognosis in Heart Failure [INTUITION]; NCT04009798) (J Am Coll Cardiol HF 2024;12:878 -889) (c) 2024 by the American College of Cardiology Foundation.