Related Experiment Videos

A tentative consensus-based model for priority setting: an example from elderly patients with myocardial infarction

Niklas Ekerstad1, Rurik Löfmark, David Andersson

  • 1The Center for Medical Technology Assessment/IMH, Linköping University, Sandbäcksgatan 7, 58183 Linköping, Sweden. niklas.ekerstad@ihs.liu.se

Scandinavian Journal of Public Health
|April 23, 2011
PubMed

Insights

A new model for prioritizing care for frail elderly heart patients, considering comorbidity, frailty, and cardiovascular risk, shows high expert agreement. This framework can guide evidence-based guidelines for complex cardiac cases in older adults.

Area of Science:

  • Cardiology
  • Geriatrics
  • Health Services Research

Background:

  • Evidence-based guidelines are crucial but challenging with weak evidence bases, particularly for frail elderly patients with heart disease.
  • A tentative model integrating cardiovascular risk, frailty, and comorbidity was developed for priority setting in this population.
  • Validating this model is essential for its practical application in clinical decision-making.

Purpose of the Study:

  • To validate the components of a proposed priority-setting model for frail elderly heart patients.
  • To assess the inter-rater reliability of expert rankings for the model's key categories.

Main Methods:

  • A confidential questionnaire study involving 58 cardiology experts.
  • Experts ranked 15 validated clinical cases based on the need for coronary angiography.
  • Inter-rater reliability was analyzed using intra-class correlation (ICC) statistics.

Main Results:

  • The model's components demonstrated very good inter-rater reliability (ICC = 0.978) among experts.
  • Comorbidity was ranked as the most relevant factor, followed by frailty and cardiovascular risk.
  • Experts found the clinical cases realistic and the model relevant for non-ST elevation myocardial infarction cases.

Conclusions:

  • A framework incorporating comorbidity, frailty, and cardiovascular risk can form the basis for consensus guidelines for frail elderly cardiac patients.
  • The proposed framework is likely applicable to other elderly patient groups with acute conditions and complex needs.
  • This approach supports evidence-based priority setting in geriatric cardiology.
Abstract

Related Concept Videos

Methods of Documentation VI: Case Management Model01:15

Methods of Documentation VI: Case Management Model

The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic illness...
Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Coronary Artery Disease V: Interprofessional Care01:27

Coronary Artery Disease V: Interprofessional Care

Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
Impact of Pharmacokinetic–Pharmacodynamic Models: Regulatory Decisions01:15

Impact of Pharmacokinetic–Pharmacodynamic Models: Regulatory Decisions

PK–PD modeling has significantly influenced FDA regulatory decisions, particularly drug approval, dosage optimization, and labeling. These models integrate pharmacokinetics (PK) and pharmacodynamics (PD) to predict drug behavior and effects, aiding in optimizing dosing regimens and enhancing the probability of clinical trial success.One notable example is Nesiritide (Natrecor®), a recombinant human brain natriuretic peptide for treating acute decompensated congestive heart failure (CHF).
Angina V: Nursing Management01:20

Angina V: Nursing Management

Angina, a symptom of myocardial ischemia, requires a structured nursing management approach to ensure effective care and prevent complications like myocardial infarction. Comprehensive nursing care involves assessing, diagnosing, planning, implementing interventions, and evaluating outcomes, all tailored to the individual patient's needs.Patient AssessmentNursing assessment begins with a detailed subjective evaluation of symptoms, which typically include chest pain or pressure radiating to the...