Influence of patient age and comorbid burden on clinician attitudes toward heart failure guidelines.

The American Journal of Geriatric Pharmacotherapy
Michael A SteinmanTerri R Fried

Abstract

Clinical practice guidelines have been criticized for insufficient attention to the unique needs of patients of advanced age and with multiple comorbid conditions. However, little empiric research is available to inform this topic. We conducted telephone interviews with staff physicians and nurse practitioners in 4 VA health care systems. Respondents were asked to rate the usefulness of national heart failure guidelines for patients of different ages and levels of comorbid burden on a 5-point scale and to comment on the reasons for their ratings. Of 139 clinicians contacted, 65 (47%) completed the interview. Almost half (49%) were women, and 48 (74%) were general internists or family practitioners. On a 5-point scale assessing the usefulness of clinical practice guidelines for heart failure, the mean (SD) response ranged from 4.4 (0.7) for patients younger than 65 years with few comorbid conditions to 3.5 (1.2) for patients older than 80 years with multiple comorbid conditions (P<0.001). The difference in perceived usefulness varied more by patient age than by degree of comorbidity (P = 0.02). Four major concepts underlay the perceived usefulness of guidelines across different patient types: (1) harm of treatment and complexity...Continue Reading

References

Oct 27, 1999·JAMA : the Journal of the American Medical Association·M D CabanaH R Rubin
Jun 21, 2001·JAMA : the Journal of the American Medical Association·L C Walter, K E Covinsky
Jan 25, 2003·BMJ : British Medical Journal·Ahmet FuatJeremy James Murphy
Apr 16, 2003·Journal of the American Geriatrics Society·Arlene F BrownUNKNOWN California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes
Jun 11, 2004·Journal of Evaluation in Clinical Practice·Gail M Powell-CopeAudrey Nelson
Aug 4, 2004·European Heart Journal·Prakash C DeedwaniaUNKNOWN MERIT-HF Study Group
Dec 31, 2004·The New England Journal of Medicine·Mary E TinettiJoseph V Agostini
Aug 11, 2005·JAMA : the Journal of the American Medical Association·Cynthia M BoydAlbert W Wu
Aug 20, 2005·Journal of the American Geriatrics Society·Sarwat I ChaudhryJohn Concato
Jun 7, 2006·Current Opinion in Cardiology·Brian R Dulin, Henry Krum
Nov 16, 2006·JAMA : the Journal of the American Medical Association·Louise C WalterBadrinath R Konety
Feb 9, 2007·Health Services Research·Elizabeth H BradleyKelly J Devers
May 23, 2007·Medical Care·Lillian C MinDavid B Reuben
Jun 15, 2007·The New England Journal of Medicine·Takahiro HigashiPaul G Shekelle
Feb 7, 2008·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Benedicte CarlsenCatherine Pope
May 26, 2009·American Heart Journal·Daniel E FormanUNKNOWN Get With the Guidelines Steering Committee and Hospitals
Dec 31, 2009·JAMA : the Journal of the American Medical Association·David B Reuben
Apr 14, 2010·Archives of Internal Medicine·Ian A Scott, Gordon H Guyatt
Jun 24, 2010·Patient Education and Counseling·Terri R FriedVirginia Towle
Oct 12, 2010·Journal of the American Geriatrics Society·Carlos A Vaz FragosoRichard A Marottoli
Mar 18, 2011·Journal of the American Geriatrics Society·Michael A SteinmanPeter J Kaboli

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