Potential flaws in the assessment of minor cerebrovascular events after heart valve replacement.
The specificity and sensitivity of the questionnaire method, whether through direct contact or via mail, in collecting information on thrombosis, embolism and bleeding after heart valve replacement were assessed by a critical analysis of methods currently in clinical use. The 16 questions contained in the standard questionnaire of the Albert Einstein College of Medicine searching for transient events were put to 1000 apparently healthy individuals. Additional questions related to risk factors such as previous heart valve replacement, any existing heart disease, hypertension, diabetes or current anticoagulant treatment for any reason were also asked. The male/female ratio was 54.9/45.1, and the mean age was 36.3 years with a range of 14-97 years. Eighty-five persons had one or more risk factors, 915 had none. A positive answer to at least one of the questions searching for TIA (transient ischemic attack) was given by 69.4% (n = 59) of those with, and by 54.8% (n = 501) without any risk factors. The total number of reported 'events' was 164 (1.93/person) for those with, and 1331 (1.45/person) for those without any risk factors. Four different follow up methods were applied to each of 123 patients after heart valve replacement: (a) regular follow up at an out-patient clinic, questionnaires sent at (b) six, (c) 18 and (d) 36 months after the start of the study. 57% of the transient and reversible events reported at the out-patient clinic were forgotten and not mentioned by the same patients in the 36 month questionnaire. One of the three permanent disabilities was also 'forgotten'.(ABSTRACT TRUNCATED AT 250 WORDS)
Bodnar
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ICR Cardiovascular Research, London.
Horstkotte
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D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000175:diagnosis / Q000209:etiology*; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D011475:Prosthesis Failure; D012307:Risk Factors