Angioplasty, bypass surgery or medical treatment: how should we decide?

Pell, Jill P.; Denvir, Martin A.

doi:10.1136/heart.88.5.451

Cited by 3 publications

(2 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar multidisciplinary approaches to clinical decisions are now widely used in oncology [ 13 - 15 ] and have been proposed previously for cardiac revascularisation [ 16 , 17 ]. As interventional cardiologists increasingly treat patients with multi-vessel disease [ 18 ] the need to carefully assess the range of options available to the patient is extremely important.…”

Section: Discussionmentioning

confidence: 99%

Variations in clinical decision-making between cardiologists and cardiac surgeons; a case for management by multidisciplinary teams?

Denvir

Pell

Lee

et al. 2006

J Cardiothorac Surg

View full text Add to dashboard Cite

Objective: To assess variations in decisions to revascularise patients with coronary heart disease between general cardiologists, interventional cardiologists and cardiac surgeons Design: Six cases of coronary heart disease were presented at an open meeting in a standard format including clinical details which might influence the decision to revascularise. Clinicians (n = 53) were then asked to vote using an anonymous electronic system for one of 5 treatment options: medical, surgical (CABG), percutaneous coronary intervention (PCI) or initially medical proceeding to revascularisation if symptoms dictated. Each case was then discussed in an open forum following which clinicians were asked to revote. Differences in treatment preference were compared by chi squared test and agreement between groups and between voting rounds compared using Kappa.Results: Surgeons were more likely to choose surgery as a form of treatment (p = 0.034) while interventional cardiologists were more likely to choose PCI (p = 0.056). There were no significant differences between non-interventional and interventional cardiologists (p = 0.13) in their choice of treatment. There was poor agreement between all clinicians in the first round of voting (Kappa 0.26) but this improved to a moderate level of agreement after open discussion for the second vote (Kappa 0.44). The level of agreement among surgeons (0.15) was less than that for cardiologists (0.34) in Round 1, but was similar in Round 2 (0.45 and 0.45 respectively) Conclusion: In this case series, there was poor agreement between cardiac clinical specialists in the choice of treatment offered to patients. Open discussion appeared to improve agreement. These results would support the need for decisions to revascularise to be made by a multidisciplinary panel.

show abstract

Section: Discussionmentioning

confidence: 99%

Variations in clinical decision-making between cardiologists and cardiac surgeons; a case for management by multidisciplinary teams?

Denvir

Pell

Lee

et al. 2006

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…[ 4 ] Given this uncertainty, some authors have called for formal or informal collaboration between physicians of different specialties, such as general internists, cardiologists, and cardiothoracic surgeons, in making PCI decisions. [ 5 - 7 ] Studies examining group processes in determining appropriateness of coronary procedures have found that physicians of diverse specialties are likely to converge on a given recommendation after discussion in a multi-specialty panel. Moreover, recommendations made through multi-disciplinary panel discussion are more consistent than those of individual physicians [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Decision-making in percutaneous coronary intervention: a survey

Rahilly‐Tierney

Nash

2008

BMC Med Inform Decis Mak

View full text Add to dashboard Cite

Background: Few researchers have examined the perceptions of physicians referring cases for angiography regarding the degree to which collaboration occurs during percutaneous coronary intervention (PCI) decision-making. We sought to determine perceptions of physicians concerning their involvement in PCI decisions in cases they had referred to the cardiac catheterization laboratory at a major academic medical center.

show abstract

The Epidemiology and Economics of Cardiothoracic Surgery in the Elderly

Etzioni

Starnes²

2011

Cardiothoracic Surgery in the Elderly

View full text Add to dashboard Cite

Angioplasty, bypass surgery or medical treatment: how should we decide?

Cited by 3 publications

References 18 publications

Variations in clinical decision-making between cardiologists and cardiac surgeons; a case for management by multidisciplinary teams?

Variations in clinical decision-making between cardiologists and cardiac surgeons; a case for management by multidisciplinary teams?

Decision-making in percutaneous coronary intervention: a survey

The Epidemiology and Economics of Cardiothoracic Surgery in the Elderly

Contact Info

Product

Resources

About