Confiabilidade entre avaliadores na estratificação de risco cardíaco com um protocolo baseado em parâmetros clínicos e físicos.

Abstract

Introduction: Existing cardiac risk stratification (CRS) protocols are not effective in predicting the occurrence of minor and more complex adverse events (AEs) in cardiac rehabilitation (CRP) programs. A new protocol based on clinical/physical variables was developed to predict the occurrence of lower AEs in these programs, and an important step to verify the existence of errors inherent to the tool and the reliability of the classification obtained by the instrument is the evaluation of the agreement between evaluators. Objective: To evaluate the inter-rater agreement of a CRT protocol based on clinical/physical variables. Methods: 62 participants who attended PRC were evaluated by two physiotherapists randomly and individually. A third physiotherapist selected the evaluation with the best result for each participant, generating a spreadsheet with unique data. Subsequently, the two physiotherapists performed the ERC twice, using the Exercise-induced sings and symtons (Exiss Score) protocol: Using the single selected data and the data from their own evaluation. The inter-rater agreement for the ERC classification with percentage of agreement and Kappa index was analyzed. For reproducibility of the Exiss Score, the intraclass correlation coefficient (ICC) was used. Results: Inter-rater agreement was 100% (single data selected) with perfect Kappa index (K: 1.00; p<0.001). However, when each evaluator used their own evaluation, the agreement was 82.3%, with Kappa of 0.37 (p=0.004). The Exiss score showed moderate reliability (ICC: 0.688 [95%CI 0.523 – 0.801] – P<0.001*) and no significant differences between the raters (41.63 ± 25.32 vs 35.57 ± 26.40; p = 0.09). Conclusion: There is 100% agreement in the ERC with the Exiss Score using the same evaluations, classified as perfect agreement in the Kappa index. In the ERC carried out through different evaluations, the agreement was 82.3%, with the Kappa index suggesting minimal agreement. There was no significant difference in the Exiss score between evaluators.