Key result
Web-based vignettes reliably assess how cardiac risk scores shape cardiologists' UA/NSTEMI management decisions.
Why the study?
Does the presence of a cardiac risk score (HEART or GRACE 2.0) and specific clinical attributes influence cardiologists' admission and invasive treatment decisions in simulated patients with suspected unstable angina or non-ST-elevation myocardial infarction?
Does the presence of a cardiac risk score (HEART or GRACE 2.0) and specific clinical attributes influence cardiologists' admission and invasive treatment decisions in simulated patients with suspected unstable angina or non-ST-elevation myocardial infarction?
This study protocol establishes a fractional factorial clinical vignette methodology to quantify how cardiac risk scores and clinical factors drive cardiologists' admission and invasive management decisions in suspected UA/NSTEMI.
Vignette tool quantifies risk-score influence on UA/NSTEMI decisions; leaves open real-world adherence to ESC guidelines.
INTRODUCTION: Cardiologists face the difficult task of rapidly distinguishing cardiac-related chest pain from other conditions, and to thoroughly consider whether invasive diagnostic procedures or treatments are indicated. The use of cardiac risk-scoring instruments has been recommended in international cardiac guidelines. However, it is unknown to what degree cardiac risk scores and other clinical information influence cardiologists' decision-making. This paper describes the development of a binary choice experiment using realistic descriptions of clinical cases. The study aims to determine the importance cardiologists put on different types of clinical information, including cardiac risk scores, when deciding on the management of patients with suspected unstable angina or non-ST-elevation myocardial infarction. METHODS AND ANALYSIS: Cardiologists were asked, in a nationwide survey, to weigh different clinical factors in decision-making regarding patient admission and treatment using realistic descriptions of patients in which specific characteristics are varied in a systematic way (eg, web-based clinical vignettes). These vignettes represent patients with suspected unstable angina or non-ST-elevation myocardial infarction. Associations between several clinical characteristics, with cardiologists' management decisions, will be analysed using generalised linear mixed models. ETHICS AND DISSEMINATION: The study has received ethics approval and informed consent will be obtained from all participating cardiologists. The results of the study will provide insight into the relative importance of cardiac risk scores and other clinical information in cardiac decision-making. Further, the results indicate cardiologists' adherence to the European Society of Cardiology guideline recommendations. In addition, the detailed description of the method of vignette development applied in this study could assist other researchers or clinicians in creating future choice experiments.
No takes yet. Share an insight, caveat, or question.
Engel et al. (2015) studied Suspected unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI). Web-based clinical vignettes with cardiac risk score information (HEART score for emergency department discharge decision; GRACE 2.0 score for coronary angiography decision) vs. Web-based clinical vignettes without cardiac risk score information was evaluated on Relative importance of clinical attributes and cardiac risk scores on cardiologists' binary management decisions: (A) emergency department discharge without further diagnostic testing, and (B) performing coronary angiography within 72 hours of admission. Web-based clinical vignettes with fractional factorial design (G efficiency 0.94-0.95) were developed to evaluate how cardiac risk scores influence cardiologists' UA/NSTEMI management decisions.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: