Elderly people with multi-morbidity and acute coronary syndrome: Doctors’ views on decision-making

Abstract

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 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 chi-square test. A content analysis was used to process the answers to the openended questions.Results: 81% of the respondents reported extensive use of national guidelines for care of heart disease in their clinical decision-making. However, when making decisions for multiplediseased elderly patients, the individual physician's own clinical experience and the patient's views on 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. Conclusion:In the future, national guidelines for heart disease should be adapted in order to be applicable for elderly patients with multiple co-morbidities.

The impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes: retrospective analysis study from the ACACIA registry

“…In the real world, some patients elect not to pursue an early invasive strategy, and this choice may be made more frequently by elderly patients, who may have concerns about their own frailty and long-term morbidity. Physicians may also judge that a patient has such substantial comorbidity that a palliative or limited approach should be undertaken 21. Despite these case-specific management decisions, it is clear from our data, however, that the elderly ACS population are underinvestigated and undertreated, and this may deny these patients the substantial benefit that is seen within 12 months.…”

Impact of comorbidities and gender on the use of coronary interventions in patients with high‐risk non‐ST‐segment elevation acute coronary syndrome

“…Serious comorbidities which might preclude the use of angiography have been difficult to define and the situation is further complicated by a lack of representation of patients with multiple comorbidities in clinical trials . Consequently, physicians' clinical experience and patients' views on treatment choice are often relied on more than guideline recommendations when making decisions in these complex circumstances .…”

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