Consensus-based priority setting for frail elderly NSTEMI (Non ST Elevation Myocardial Infarction) patients
2010 (English)Conference paper (Refereed)
Introduction: Evidence based medicine is difficult to practice when the evidence base is weak. Priority setting for frail elderly patients with heart disease illustrates this problem. We have constructed a tentative model for priority setting for frail elderly patients. Our aim is to evaluate its potential to predict experts’ priority setting. Methods: The tentative model, taking into account cardiovascular risk, frailty and co-morbidity, was based on a literature review, a register study and a questionnaire study. In a pilot study six experienced cardiologists were confronted with 15 validated authentic NSTEMI cases, all of them with different patterns of co-morbidity and frailty. We evaluated the convergence between the rankings of the individual cardiologists and also whether these rankings were in accordance with the suggested model rankings. In the ongoing main study participating cardiologists were recommended by experts. The convergence is measured via an intra-class correlation test. Results: Respondents in the pilot study considered the cases to be clear and relevant. The convergence was evident, both between the cardiologists´ rankings and regarding the model’s suggested rankings compared to the cardiologists’ rankings. The model components were considered relevant and important. The current main study evaluates the same issues on a larger scale. The results will soon be reported. Conclusions: In order to enhance the usability of guidelines in cardiology, they ought to be adapted to frail elderly patients. Our tentative model constitutes a first step in a process towards experts’ consensus-based priority setting when the evidence base is weak.
Place, publisher, year, edition, pages
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:liu:diva-56311OAI: oai:DiVA.org:liu-56311DiVA: diva2:318327
8th International Conference on Priorities in Health Care, 2010, Boston