Patients often confuse acute MI, other conditions in self-reports

Researchers looking into patient-reported and medically recorded MI found significant discordance between them, with telling differences. Patients who self-report acute MI may have a doubled mortality risk, even if their records say they have no history of a heart attack.

Laura C. Yasaitis, PhD, from the Harvard Center for Population and Development Studies at Harvard University in Cambridge, Mass., and colleagues collected data on over 45,000 patients. They compared data from the Health and Retirement Study and Medicare claims to better understand the difference between patient-reported and claims-identified cases of acute MI and acute coronary syndromes.

A total of 3.1 percent of patients self-reported acute MI within the past 2.5 years. Claims data on these self-reported acute MI patients identified only 32.3 percent had clinically reported acute MI and 48.7 percent had acute coronary syndromes. Among 17.3 percent of self-reported acute MI patients, no inpatient admissions of any kind were found in the preceding 2.5 years.

When looking at it from the other side, 1.4 percent of the total cohort had claims-identified acute MI in the prior two years. Heart problems were reported in 90.5 percent of these patients; however, around two thirds of claims-identified acute MI patients (67.8 percent) self-reported acute MI.

They found older patients were less likely to self-report acute MI or heart problems, as were patients who had less than a high school education. Patients were also less likely to self-report MI if they had limitations on daily living activities or had poor word recall.

Patients were more likely to report a heart attack if major surgical or imaging intervention had been involved, such as receiving a stent, undergoing CABG or PCI.

While it would seem that patient-reporting may be unreliable, Yasaitis et al cautioned that it still had significance. Patients who self-reported, whether they’d had an acute MI or not, were more likely to die within one year.

“Physicians should definitely still be listening to their patients,” Yasaitis said in a press release. “The self-report does have importance, but you also have to look at what it means, whether it is in fact a heart attack or a sign that there might be other, more complex illnesses in their history.”

The study was published online March 6 in Circulation.