title: Physicians' perceptions of the Thrombolysis in Myocardial Infarction (TIMI) risk score in older adults with acute myocardial infarction.
abstract: OBJECTIVE
  To evaluate physician-perceived strengths and limitations of the Thrombolysis in Myocardial Infarction (TIMI) risk scores for use in older adults with acute myocardial infarction (AMI).
  
  
  BACKGROUND
  The TIMI risk scores are risk stratification models developed to estimate mortality risk for patients hospitalized for AMI. However, these models were developed and validated in cohorts underrepresenting older adults (≥75 years).
  
  
  METHODS
  Qualitative study using semi-structured telephone interviews and the constant comparative method for analysis.
  
  
  RESULTS
  Twenty-two physicians completed interviews ranging 10-30 min (mean = 18 min). Median sample age was 37 years, with a median of 11.5 years of clinical experience. TIMI strengths included familiarity, ease of use, and validation. Limitations included a lack of risk factors relevant to older adults and model scope and influence.
  
  
  CONCLUSIONS
  Physicians report that the TIMI models, while widely used in clinical practice, have limitations when applied to older adults. New risk models are needed to guide AMI treatment in this population.
authors.affiliation: Yale School of Nursing, P.O. Box 27399, West Haven, CT 06516-7399, USA. Electronic address: shelli.feder@yale.edu.
authors.forename: Shelli L
authors.initials: SL
authors.lastname: Feder
authors.affiliation: Yale School of Nursing, P.O. Box 27399, West Haven, CT 06516-7399, USA.
authors.forename: Dena
authors.initials: D
authors.lastname: Schulman-Green
authors.affiliation: Yale School of Medicine, Program on Aging, 300 George Street Suite 775, New Haven, CT 06510, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Geda
authors.affiliation: Yale School of Medicine, Program on Aging, 300 George Street Suite 775, New Haven, CT 06510, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Williams
authors.affiliation: Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Dodson
authors.affiliation: Yale-New Haven Hospital, Department of Internal Medicine, 330 Cedar Street, P.O. Box 208056, New Haven, CT 06520-8056, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Nanna
authors.affiliation: Yale School of Medicine, Program on Aging, 300 George Street Suite 775, New Haven, CT 06510, USA.
authors.forename: Heather G
authors.initials: HG
authors.lastname: Allore
authors.affiliation: Yale School of Medicine, Division of Geriatrics, 333 Cedar Street, P.O. Box 208025, New Haven, CT 06520-2085, USA.
authors.forename: Terrence E
authors.initials: TE
authors.lastname: Murphy
authors.affiliation: Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT 06520-8034, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Tinetti
authors.affiliation: Yale School of Medicine, Division of Geriatrics, 333 Cedar Street, P.O. Box 208025, New Haven, CT 06520-2085, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Gill
authors.affiliation: Yale School of Medicine, Department of General Internal Medicine, 330 Cedar Street, P.O. Box 208056, New Haven, CT 06520-8056, USA.
authors.forename: Sarwat I
authors.initials: SI
authors.lastname: Chaudhry
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality*; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment / Q000379:methods*
keywords: Aging; Myocardial infarction; Older adult; Risk factors; Risk stratification model