title: Good interobserver agreement was attainable on outcome adjudication in patients with stable coronary heart disease.
abstract: OBJECTIVE
  In clinical trials, agreement on outcomes is of utmost importance for valid estimation of intervention effects. As there is limited knowledge about adjudicator agreement in cardiology, we examined the level of agreement among three cardiology specialists adjudicating all possible events in a randomized controlled clinical trial of patients with stable coronary heart disease.
  
  
  METHODS
  All information (hospital records, death certificates, etc.) was forwarded to two randomly selected blinded adjudicators. If they disagreed, the third arbiter had to choose the more likely of the two alternatives. Files of 5,475 nonfatal and 362 fatal events were evaluated.
  
  
  RESULTS
  For nonfatal outcomes, pairwise kappa values ranged from 0.75 to 0.80. The three adjudicators had 4.3%, 9.5%, and 6.1% of their nonfatal outcome classifications overruled by their arbiter. If stable angina pectoris, unstable angina pectoris, and acute myocardial infarction were treated as one, agreement increased minimally. For fatal outcomes, the pairwise kappa values ranged from 0.65 to 0.90. The three adjudicators had 12%, 9%, and 10% of their death classifications overruled.
  
  
  CONCLUSIONS
  Specialists in cardiology can attain a reasonably high agreement on outcomes in patients with stable coronary heart disease.
authors.affiliation: Department of Cardiology, Copenhagen University Hospital, Herlev Hospital, Herlev Ringvej 75, Herlev, Denmark. kjoller@dadlnet.dk
authors.forename: Erik
authors.initials: E
authors.lastname: Kjoller
authors.forename: Jorgen
authors.initials: J
authors.lastname: Hilden
authors.forename: Per
authors.initials: P
authors.lastname: Winkel
authors.forename: Niels J
authors.initials: NJ
authors.lastname: Frandsen
authors.forename: Soren
authors.initials: S
authors.lastname: Galatius
authors.forename: Gorm
authors.initials: G
authors.lastname: Jensen
authors.forename: Jens
authors.initials: J
authors.lastname: Kastrup
authors.forename: Jorgen Fischer
authors.initials: JF
authors.lastname: Hansen
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Kolmos
authors.forename: Christian M
authors.initials: CM
authors.lastname: Jespersen
authors.forename: Per
authors.initials: P
authors.lastname: Hildebrandt
authors.forename: Christian
authors.initials: C
authors.lastname: Gluud
mesh_terms: D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002690:Chlamydia Infections / Q000150:complications*; D016993:Chlamydophila pneumoniae / Q000302:isolation & purification; D017291:Clarithromycin / Q000627:therapeutic use*; D016001:Confidence Intervals; D003327:Coronary Disease / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000628:therapy; D003718:Denmark; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000382:microbiology / Q000628:therapy; D015588:Observer Variation; D011379:Prognosis; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D017291:Clarithromycin