Variability in treatment advice for elderly patients with aortic stenosis: a nationwide survey in the Netherlands

• Published in: Heart (British Cardiac Society) Vol. 85; no. 2; pp. 196 - 201
• Main Authors: Bouma, B J, van der Meulen, J H P, van den Brink, R B A, Arnold, A E R, Smidts, A, Teunter, L H, Lie, K I, Tijssen, J G P
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.02.2001; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: Adult; Age; Age Factors; Aged; Aged patients; Aged, 80 and over; aortic stenosis; aortic valve replacement; Aortic valve stenosis; Aortic Valve Stenosis - surgery; Attitude of Health Personnel; Biological and medical sciences; Cardiologists; Cardiology; Cardiovascular disease; Classification; clinical decision making; Coronary vessels; Counseling - statistics & numerical data; Decision Making; Design; elderly patients; Family medical history; Female; Health Care Surveys; Heart failure; Heart Valve Prosthesis Implantation - statistics & numerical data; Hospitals; Humans; Interventional Cardiology Surgery; Linear Models; Male; Marketing; Medical sciences; Methods; Middle age; Middle Aged; Mortality; Netherlands; Patient Selection; Patients; Practice Patterns, Physicians' - statistics & numerical data; Prognosis; Questionnaires; Stroke; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surveys; Surveys and Questionnaires; Therapeutics, Surgical; Netherlands; Europe; Human; Decision making; Treatment efficiency; Variability; Cardiovascular disease; Exploration; Narrowing; Treatment; Cardiac valvular disease; Medical prescription; Surgery; Professional practice; Elderly; Aortic valve; Public health
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heart.85.2.196

OBJECTIVE To determine how the decisions of Dutch cardiologists on surgical treatment for aortic stenosis were influenced by the patient's age, cardiac signs and symptoms, and comorbidity; and to identify groups of cardiologists whose responses to these clinical characteristics were similar. DESIGN A questionnaire was produced asking cardiologists to indicate on a six point scale whether they would advise cardiac surgery for each of 32 case vignettes describing 10 clinical characteristics. SETTING Nationwide postal survey among all 530 cardiologists in the Netherlands. RESULTS 52% of the cardiologists responded. There was wide variability in the cardiologists' advice for the individual case vignettes. Six groups of cardiologists explained 60% of the variance. The age of the patient was most important for 41% of the cardiologists; among these, 50% had a high and 50% a low inclination to advise surgery. A further 24% were influenced equally by the patient's age and by the severity of the aortic stenosis and its effect on left ventricular function; among these, 62% had a high and 38% a low inclination to advise surgery. Finally, 23% of the cardiologists were mainly influenced by the left ventricular function and 12% by the aortic valve area. The presence of comorbidity always played a minor role. CONCLUSIONS There were systematic differences among groups of cardiologists in their inclination to advise aortic valve replacement for elderly patients, as well as in the way their advice was influenced by the patients' characteristics. These results indicate the need for prospective studies to identify the best treatment for elderly patients according to their clinical profile.