Chete Eze-Nliam, Kellie Cain, Kasey Bond, Keith Forlenza, Rachel Jankowski, Gina Magyar-Russell, Gayane Yenokyan and Roy C Ziegelstein contributed equally to this work.
The authors declare that they have no competing interests.
CME participated in the design of the study, performed the statistical analysis, coordinated and drafted the manuscript. KC participated in the design of the study and helped to draft the manuscript. KB participated in the design of the study and helped to draft the manuscript. KF participated in the design of the study and helped to draft the manuscript. RJ participated in the design of the study and helped to draft the manuscript. GMR participated in the design of the study and helped to draft the manuscript. GY participated in the design of the study and performed the statistical analysis. RCZ conceived of the study, participated in its design, coordinated and helped to draft the manuscript. All authors read and approved the final manuscript.
Many critical treatment decisions are based on the medical history of patients with an acute coronary syndrome (ACS). Discrepancies between the medical history documented by a health professional and the patient's own report may therefore have important health consequences.
Medical histories of 117 patients with an ACS were documented. A questionnaire assessing the patient's health history was then completed by 62 eligible patients. Information about 13 health conditions with relevance to ACS management was obtained from the questionnaire and the medical record. Concordance between these two sources and reasons for discordance were identified.
There was significant variation in agreement, from very poor in angina (kappa < 0) to almost perfect in diabetes (kappa = 0.94). Agreement was substantial in cerebrovascular accident (kappa = 0.76) and hypertension (kappa = 0.73); moderate in cocaine use (kappa = 0.54), smoking (kappa = 0.46), kidney disease (kappa = 0.52) and congestive heart failure (kappa = 0.54); and fair in arrhythmia (kappa = 0.37), myocardial infarction (kappa = 0.31), other cardiovascular diseases (kappa = 0.37) and bronchitis/pneumonia (kappa = 0.31). The odds of agreement was 42% higher among individuals with at least some college education (OR = 1.42; 95% CI, 1.00 - 2.01, p = 0.053). Listing of a condition in medical record but not in the questionnaire was a common cause of discordance.
Discrepancies in aspects of the medical history may have important effects on the care of ACS patients. Future research focused on identifying the most effective and efficient means to obtain accurate health information may improve ACS patient care quality and safety.