Abstract:
BACKGROUND:It is unclear whether patients understand that percutaneous coronary intervention (PCI) reduces only chronic stable angina and not myocardial infarction (MI) or associated mortality. OBJECTIVE:To compare cardiologists' and patients' beliefs about PCI. DESIGN:Survey. SETTING:Academic center. PARTICIPANTS:153 patients who consented to elective coronary catheterization and possible PCI, 10 interventional cardiologists, and 17 referring cardiologists. MEASUREMENTS:Patients' and cardiologists' beliefs about benefits of PCI. All cardiologists reported beliefs about PCI for patients in hypothetical scenarios. Interventional cardiologists also reported beliefs for study patients who underwent PCI. RESULTS:Of 153 patients, 68% had any angina, 42% had activity-limiting angina, 77% had a positive stress test result, and 29% had had previous MI. The 53 patients who underwent PCI were more likely than those who did not to have a positive stress test result, but angina was similar in both groups. Almost three quarters of patients thought that without PCI, they would probably have MI within 5 years, and 88% believed that PCI would reduce risk for MI. Patients were more likely than physicians to believe that PCI would prevent MI (prevalence ratio, 4.25 [95% CI, 2.31 to 7.79]) or fatal MI (prevalence ratio, 4.83 [CI, 2.23 to 10.46]). Patients were less likely than their physicians to report pre-PCI angina (prevalence ratio, 0.79 [CI, 0.67 to 0.92]). For the scenarios, 63% of cardiologists believed that the benefits of PCI were limited to symptom relief. Of cardiologists who identified no benefit of PCI in 2 scenarios, 43% indicated that they would still proceed with PCI in these cases. LIMITATION:The study was small and conducted at 1 center, and information about precatheterization counseling was limited. CONCLUSION:Cardiologists' beliefs about PCI reflect trial results, but patients' beliefs do not. Discussions with patients before PCI should better explain anticipated benefits. PRIMARY FUNDING SOURCE:None.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Rothberg MB,Sivalingam SK,Ashraf J,Visintainer P,Joelson J,Kleppel R,Vallurupalli N,Schweiger MJdoi
10.7326/0003-4819-153-5-201009070-00005subject
Has Abstractpub_date
2010-09-07 00:00:00pages
307-13issue
5eissn
0003-4819issn
1539-3704pii
153/5/307journal_volume
153pub_type
杂志文章abstract::To characterize the role of cardiac function in septic shock, serial radionuclide cineangiographic and hemodynamic evaluations were done on 20 patients with documented septic shock. Although all patients had a normal or elevated cardiac index, 10 patients had moderate to severe depression of their ejection fraction wi...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-100-4-483
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abstract::Adverse effects to D-penicillamine were studied prospectively over 3 years in 259 patients with rheumatoid arthritis. Ninety-five percent had had gold therapy previously, yet 70% benefited from D-penicillamine therapy. Of the 275 courses given, 160 (58%) were complicated by at least one reaction, including rashes (44%...
journal_title:Annals of internal medicine
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abstract::Multiple myeloma raises a number of puzzling questions about the production of immunoglobulins and the malignant transformation of lymphoid cells. Some of these questions can be approached by studying mouse plasmacytomas and by genetic and biochemical studies of mouse myeloma cells in culture. The synthesis, assembly,...
journal_title:Annals of internal medicine
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abstract::Disturbances of urinary bladder function are well-recognized problems in diabetic patients and are generally attributed to peripheral neuropathy. Because of the difficulties inherent in the histologic examination of the peripheral autonomic nerves, little is known about the pathology of these nerves. Recently, alterat...
journal_title:Annals of internal medicine
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abstract:OBJECTIVE:To describe the course of rheumatoid arthritis over 5 years in adults and to evaluate the effect of parenterally administered gold salts on that course. DESIGN:A prospective observational study of adults with rheumatoid arthritis. Data derived from annual interviews with patients from 1983 to 1988 and from p...
journal_title:Annals of internal medicine
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journal_title:Annals of internal medicine
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journal_title:Annals of internal medicine
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