| Autor: |
Wilson TA; Department of Medicine University of Calgary Calgary Alberta Canada., Hazlewood GS; Department of Medicine University of Calgary Calgary Alberta Canada., Sajobi TT; Department of Community Health Sciences University of Calgary Calgary Alberta Canada., Wilton SB; Department of Community Health Sciences University of Calgary Calgary Alberta Canada.; Department of Cardiac Sciences University of Calgary Calgary Alberta Canada., Pearson WE; Patient and Community Engagement Research Program, O'Brien Institute of Public Health University of Calgary Calgary Alberta Canada., Connolly C; Patient and Community Engagement Research Program, O'Brien Institute of Public Health University of Calgary Calgary Alberta Canada., Javaheri PA; Department of Medicine University of Calgary Calgary Alberta Canada., Finlay JL; Department of Medicine University of Calgary Calgary Alberta Canada., Levin A; Division of Nephrology University of British Columbia Vancouver British Columbia Canada., Graham MM; Department of Medicine, Division of Cardiology University of Alberta Edmonton Alberta Canada., Tonelli M; Department of Medicine University of Calgary Calgary Alberta Canada., James MT; Department of Medicine University of Calgary Calgary Alberta Canada.; Department of Community Health Sciences University of Calgary Calgary Alberta Canada. |
| Jazyk: |
angličtina |
| Zdroj: |
Journal of the American Heart Association [J Am Heart Assoc] 2023 Mar 21; Vol. 12 (6), pp. e028492. Date of Electronic Publication: 2023 Mar 09. |
| DOI: |
10.1161/JAHA.122.028492 |
| Abstrakt: |
Background Patients with chronic kidney disease (CKD) can experience acute coronary syndromes (ACS) with high morbidity and mortality. Early invasive management of ACS is recommended for most high-risk patients; however, choosing between an early invasive versus conservative management approach may be influenced by the unique risk of kidney failure for patients with CKD. Methods and Results This discrete choice experiment measured the preferences of patients with CKD for future cardiovascular events versus acute kidney injury and kidney failure following invasive heart procedures for ACS. The discrete choice experiment, consisting of 8 choice tasks, was administered to adult patients attending 2 CKD clinics in Calgary, Alberta. The part-worth utilities of each attribute were determined using multinomial logit models, and preference heterogeneity was explored using latent class analysis. A total of 140 patients completed the discrete choice experiment. The mean age of patients was 64 years, 52% were male, and mean estimated glomerular filtration rate was 37 mL/min per 1.73 m 2 . Across the range of levels, risk of mortality was the most important attribute, followed by risk of end-stage kidney disease and risk of recurrent myocardial infarction. Latent class analysis identified 2 distinct preference groups. The largest group included 115 (83%) patients, who placed the greatest value on treatment benefits and expressed the strongest preference for reducing mortality. A second group of 25 (17%) patients was identified who were procedure averse and had a strong preference toward conservative management of ACS and avoiding acute kidney injury requiring dialysis. Conclusions The preferences of most patients with CKD for management of ACS were most influenced by lowering mortality. However, a distinct subgroup of patients was strongly averse to invasive management. This highlights the importance of clarifying patient preferences to ensure treatment decisions are aligned with patient values. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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