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

Shelli L. Feder, Dena Schulman-Green, John A. Dodson, Mary Geda, Kathleen Williams, Michael G. Nanna, Heather G. Allore, Terrence E. Murphy, Mary E. Tinetti, Thomas M. Gill, Sarwat I. Chaudhry

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)387-402
Number of pages16
JournalJournal of Aging and Health
Volume28
Issue number3
DOIs
StatePublished - Apr 1 2016

Keywords

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

ASJC Scopus subject areas

  • Health(social science)
  • Sociology and Political Science
  • Life-span and Life-course Studies

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    Feder, S. L., Schulman-Green, D., Dodson, J. A., Geda, M., Williams, K., Nanna, M. G., Allore, H. G., Murphy, T. E., Tinetti, M. E., Gill, T. M., & Chaudhry, S. I. (2016). Risk Stratification in Older Patients with Acute Myocardial Infarction: Physicians' Perspectives. Journal of Aging and Health, 28(3), 387-402. https://doi.org/10.1177/0898264315591005