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J Aging Health. 2016 Apr;28(3):387-402. doi: 10.1177/0898264315591005. Epub 2015 Jun 22.

Risk Stratification in Older Patients With Acute Myocardial Infarction: Physicians' Perspectives.

Author information

1
Yale University School of Nursing, Orange, CT, USA shelli.feder@yale.edu.
2
Yale University School of Nursing, Orange, CT, USA.
3
New York University School of Medicine, New York City, USA.
4
Yale University School of Medicine, New Haven, CT, USA.
5
Yale-New Haven Hospital, New Haven, CT, USA.

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.

METHOD:

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.

DISCUSSION:

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.

KEYWORDS:

acute myocardial infarction; medical decision making; older adult; qualitative methodology; risk stratification models

PMID:
26100619
PMCID:
PMC4886275
DOI:
10.1177/0898264315591005
[Indexed for MEDLINE]
Free PMC Article

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