Abstract:
BACKGROUND/OBJECTIVES:The extent to which individual knowledge, preferences, and priorities explain lower use of invasive cardiac care among older vs. younger adults presenting with acute coronary syndrome (ACS) is unknown. We directly surveyed a group of patients to ascertain their preferences and priorities for invasive cardiovascular care. DESIGN:We performed a prospective cohort study of adults hospitalized with ACS. We surveyed participants regarding their knowledge, preferences, goals, and concerns for cardiac care, as well as their risk tolerance for coronary artery bypass grafting (CABG). SETTING:Single academic medical center. PARTICIPANTS:Six hundred twenty-eight participants (373 <75 years old; 255 ≥75 years old). MEASUREMENTS:We compared baseline characteristics, knowledge, priorities, and risk tolerance for care across age strata. We also assessed pairwise differences with 95% confidence intervals (CI) between age groups for key variables of interest. RESULTS:Compared with younger patients, older participants had less knowledge of invasive care; were less willing to consider cardiac catheterization (difference between 75-84 and< 65 years old: -7.8%, 95% CI: -14.4%,-1.3%; for ≥85 vs. <65: -15.7%, 95% CI: -29.8%,-1.6%), percutaneous coronary intervention (difference between 75-84 and< 65 years old: -12.8%, 95% CI: -20.8%,-4.8%; for ≥85 vs. <65: -24.8%, 95% CI: -41.2%,-8.5%), and CABG (difference between 75-84 and< 65 years old: -19.0%, 95% CI: -28.2%,-9.9%; for ≥85 vs. <65: -39.1%, 95% CI: -56.0%,-22.2%); and were more risk averse for CABG surgery (p < .001), albeit with substantial inter-individual variability and individual outliers. Many patients who stated they were not initially willing to undergo an invasive cardiovascular procedure actually ended up undergoing the procedure (49% for cardiac catheterization and 22% for PCI or CABG). CONCLUSION:Age influences treatment goals and willingness to consider invasive cardiac care, as well as risk tolerance for CABG. Individuals' willingness to undergo invasive cardiovascular procedures loosely corresponds with whether that procedure is performed after discussion with the care team.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Nanna MG,Peterson ED,Wu A,Harding T,Galanos AN,Wruck L,Alexander KPdoi
10.1016/j.ahj.2019.09.008subject
Has Abstractpub_date
2020-01-01 00:00:00pages
99-108eissn
0002-8703issn
1097-6744pii
S0002-8703(19)30266-2journal_volume
219pub_type
杂志文章abstract::Left ventricular mass (LVM) measurements made by the truncated ellipsoid algorithm from clinical two-dimensional echocardiograms (2DE) were compared to autopsy weights in 37 patients. All six 2DE instruments were calibrated with an ultrasound phantom to standardize LVM measurements. Measurements were made by an experi...
journal_title:American heart journal
pub_type: 杂志文章
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abstract::The relation of alcohol consumption to coronary heart disease (CHD) was examined in a cohort of 1910 employed men aged 38 to 55 years enrolled in the Albany Study, a prospective investigation of factors related to cardiovascular disease. Two follow-up periods were examined, one between 1953-54 and 1971-72, the other a...
journal_title:American heart journal
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pub_type: 杂志文章,多中心研究,随机对照试验
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pub_type: 杂志文章,多中心研究,随机对照试验
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pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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pub_type: 杂志文章,多中心研究
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更新日期:2018-01-01 00:00:00
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journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(05)80050-x
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pub_type: 杂志文章
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更新日期:2012-09-01 00:00:00
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更新日期:2011-11-01 00:00:00
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pub_type: 杂志文章
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更新日期:1994-03-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2004-08-01 00:00:00
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pub_type: 杂志文章,多中心研究
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更新日期:2020-04-01 00:00:00
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pub_type: 临床试验,杂志文章
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