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Elderly people with multi-morbidity and acute coronary syndrome: doctors' views on decision-making
Niklas Ekerstad1, Rurik Löfmark, Per Carlsson
1The Center for Medical Technology Assessment/IMH, Linköping University, Linköping, Sweden. niklas.ekerstad@ihs.liu.se
Insights
Swedish cardiologists rely more on experience and patient preferences than guidelines for elderly heart patients with multiple conditions. Guidelines need adaptation for this complex patient group.
Area of Science:
- Cardiology
- Geriatrics
- Evidence-based Medicine
Background:
- Healthcare resource limitations in Western countries emphasize evidence-based guidelines.
- Weak evidence bases pose challenges, particularly for elderly patients with multiple co-morbidities and heart disease.
Purpose of the Study:
- To assess Swedish cardiologists' perspectives on clinical decision-making for elderly patients with multiple co-morbidities and non-ST-elevation acute coronary syndrome (NSTE ACS).
- To formulate hypotheses for future research on optimizing care for this demographic.
Main Methods:
- A confidential questionnaire survey distributed to 370 cardiologists/internists.
- A 69% response rate was achieved, with data analyzed using descriptive statistics and chi-square tests.
- Content analysis was employed for open-ended responses.
Main Results:
- 81% of respondents reported frequent use of national heart disease guidelines.
- Clinical experience and patient preferences were prioritized over national guidelines for elderly patients with multiple co-morbidities.
- Around 50% of cardiologists manage elderly patients with NSTE ACS daily.
- Key recommendations included conducting treatment studies in this population and developing specific guidelines.
Conclusions:
- National heart disease guidelines require adaptation to effectively serve elderly patients with multiple co-morbidities.
- Future guidelines should be tailored to the unique needs of this patient cohort.
Background:
In most Western countries the growing gap between available resources and greater potential for medical treatment has brought evidence-based guidelines into focus. However, problems exist in areas where the evidence base is weak, e.g. elderly patients with heart disease and multiple co-morbidities.
Objective:
Our aim is to evaluate the views of Swedish cardiologists on decision-making for elderly people with multiple co-morbidities and acute coronary syndrome without ST-elevation (NSTE ACS), and to generate some hypotheses for testing.
Methods:
A confidential questionnaire study was conducted to assess the views of cardiologists/internists (n = 370). The response rate was 69%. Responses were analyzed with frequencies and descriptive statistics. When appropriate, differences in proportions were assessed by a chi-square test. A content analysis was used to process the answers to the open-ended questions.
Results:
81% of the respondents reported extensive use of national guidelines for care of heart disease in their clinical decision-making. However, when making decisions for multiple-diseased elderly patients, the individual physician's own clinical experience and the patient's views on treatment choice were used to an evidently greater extent than national guidelines. Approximately 50% estimated that they treated multiple-diseased elderly patients with NSTE ACS every day. Preferred measures for improving decision-making were: (a) carrying out treatment studies including elderly patients with multiple co-morbidities, and (b) preparing specific national guidelines for multiple-diseased elderly patients.
Conclusions:
In the future, national guidelines for heart disease should be adapted in order to be applicable for elderly patients with multiple co-morbidities.
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