Elderly people with multi-morbidity and acute coronary syndrome: doctors' views on decision-making.
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 guidelines 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 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.


CONCLUSIONS
In the future, national guidelines for heart disease should be adapted in order to be applicable for elderly patients with multiple co-morbidities.
Ekerstad
Niklas
N
The Center for Medical Technology Assessment/IMH, Linköping University, Linköping, Sweden. niklas.ekerstad@ihs.liu.se
Löfmark
Rurik
R
Carlsson
Per
P
D054058:Acute Coronary Syndrome / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D015897:Comorbidity; D003657:Decision Making; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires