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

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.