Elderly people with multi-morbidity and acute coronary syndrome: Doctors' views on decision-making
2010 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 38, no 3, 325-331 p.Article in journal (Refereed) Published
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 quidelines 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 of 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.
Place, publisher, year, edition, pages
2010. Vol. 38, no 3, 325-331 p.
Acute coronary syndrome, co-morbidity, decision-making, elderly, guidelines
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-56309DOI: 10.1177/1403494809354359ISI: 000277168800014OAI: oai:DiVA.org:liu-56309DiVA: diva2:318324
The final, definitive version of this paper has been published in:
Scandinavian Journal of Public Health, (38), 3, 325-331, 2010.
Niklas Ekerstad, Rurik Löfmark and Per Carlsson, Elderly people with multi-morbidity and acute coronary syndrome: Doctors' views on decision-making
by SAGE Publications Ltd, All rights reserved.