title: Risk Stratification in Older Patients With Acute Myocardial Infarction: Physicians' Perspectives.
abstract: OBJECTIVE
  Risk stratification models support clinical decision making in acute myocardial infarction (AMI) care. Existing models were developed using data from younger populations, potentially limiting accuracy and relevance in older adults. We describe physician-perceived risk factors, views of existing models, and preferences for future model development in older adults.
  
  
  METHODS
  Qualitative study using semi-structured telephone interviews and the constant comparative method.
  
  
  RESULTS
  Twenty-two physicians from 14 institutions completed the interviews. Median age was 37, and median years of clinical experience was 11.5. Perceived predictors included cardiovascular, comorbid, functional, and social risk factors. Physicians viewed models as easy to use, yet neither inclusive of risk factors nor predictive of non-mortality outcomes germane to clinical decision making in older adults. Ideal models included multidimensional risk domains and operational requirements.
  
  
  CONCLUSIONS
  Physicians reported limitations of available risk models when applied to older adults with AMI. New models are needed to guide AMI treatment in this population.
authors.affiliation: Yale University School of Nursing, Orange, CT, USA shelli.feder@yale.edu.
authors.forename: Shelli L
authors.initials: SL
authors.lastname: Feder
authors.affiliation: Yale University School of Nursing, Orange, CT, USA.
authors.forename: Dena
authors.initials: D
authors.lastname: Schulman-Green
authors.affiliation: New York University School of Medicine, New York City, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Dodson
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Geda
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Williams
authors.affiliation: Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Nanna
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Heather G
authors.initials: HG
authors.lastname: Allore
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Terrence E
authors.initials: TE
authors.lastname: Murphy
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Tinetti
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Gill
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Sarwat I
authors.initials: SI
authors.lastname: Chaudhry
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009203:Myocardial Infarction / Q000628:therapy*; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D036301:Qualitative Research; D018570:Risk Assessment; D012307:Risk Factors
keywords: acute myocardial infarction; medical decision making; older adult; qualitative methodology; risk stratification models