Octogenarian preferences and expectations for acute coronary syndrome treatment.

BACKGROUND: The number of elderly persons with cardiovascular disease is increasing. In Sweden, the incidence of acute myocardial infarction is the highest among individuals aged 85 years and over. However, there is still little evidence about whether this population benefits from established treatments. Furthermore, the values and preferences of octogenarians (age ⩾80 years), as well as how they could be involved in treatment decisions, have been largely overlooked in research. Overall, increased knowledge about the preferences and expectations of octogenarians is needed to incorporate their treatment expectations into the decision-making process. AIMS: This study aimed to describe the treatment choice preferences and post-treatment life expectations of octogenarians with acute coronary syndrome. METHODS: A total of 19 patients (eight women, 11 men) aged 80 years and older and diagnosed with non-ST-elevation myocardial infarction or unstable angina were enrolled in this qualitative study. Data were collected between May 2011 and June 2013 through semistructured interviews. The data were analysed using qualitative content analysis. RESULTS: We identified two main categories: Wanting the best and Hope for increased wellbeing. Participant preferences were influenced by their own and others' previous experiences and their confidence in healthcare professionals. With respect to treatment outcomes, the participants hoped to get well, stay active, experience fewer symptoms and regain vitality. CONCLUSION: The studied octogenarians desired the best treatment option and trusted that their healthcare providers will make appropriate recommendations. These patients expected their treatment to result in increased wellbeing and fewer symptoms.

Patients expectations and fulfilment of expectations before and after treatment for suspected coronary artery disease assessed with a newly developed questionnaire in combination with established health-related quality of life questionnaires.

BACKGROUND: Clinical decision-making is often based on evidence of outcome after a specific treatment. Healthcare providers and patients may, however, have different perceptions and expectations of what to achieve from a certain healthcare measure. AIMS: To evaluate patients' expectations, perceptions and health related quality of life (HRQoL) before a care process including coronary angiography for suspected coronary artery disease and to evaluate the fulfilment of these expectations in relation to established patient reported outcome measures (PROMs) 6 months later. Furthermore, an aim was to try to define meaningful patient reported experience measures (PREMs) in this population. METHODS: 544 patients planned for coronary angiography completed a newly developed questionnaire to assess expectations and perceptions of treatment, the expectation questionnaire (ExpQ) and two established HRQoL questionnaires together with the established generic Short-Form 36 (SF36) and the disease specific Seattle Angina Questionnaire (SAQ). RESULTS: Patients had before the intervention, in general, high expectations of improvement after investigation and treatment and there was a positive attitude towards life style changes, medication and participation in decision-making regarding their own treatment. Only, 56.4% of the patients, however, reported fulfilment of treatment expectations. Fulfilment of treatment expectations correlated strongly with improvement in HRQoL after the care process. CONCLUSIONS: To measure patients ´ expectations and fulfilments of these may offer simple and meaningful outcomes to evaluate a healthcare process from a patient ´s perspective. To approach patients' expectations may also strengthen patient involvement in the care process with the possibilities of both higher patient satisfaction and medical results of the treatment.

Characteristics of heart failure in the elderly--a hospital cohort registry-based study.

UNLABELLED: Heart failure patient in the elderly is a growing population with poor prognosis. However this patient population has not been well studied. The present study is based on a hospital cohort heart failure registry during 2005 at Heart Failure Centre Medicine, Dept. of Medicine, SU/Sahlgrenska Hospital. In this study 150 patients were enrolled consecutively for analysis. They are aged around 80 years old with high comorbidity. One-year mortality is 30%. Multivariate analyses demonstrated that significant prognostic indicators for mortality are increasing age, New York Heart Association functional class and presence of comorbidities such as chronic obstructive pulmonary disease and renal failure. The use of aldosterone receptor antagonist is also associated with poor prognosis. Prescriptions of ACE inhibitor and beta-blockers are 57.5% and 73% respectively. Added-on therapy with angiotensin receptor 1 antagonist is few. In around 30% of prescriptions of ACE inhibitors daily dose is less than half of target dose. In around 54% of beta-blockers daily dose is less than half of target dose. There are clear potential for improved medications with guideline recommended agents in light of the fact that in these study patients 82% of heart rates is >60 beats/min, 84% of S-creatinine is <150 mmol/l, 17.4% of systolic blood pressure is 140-160 mmHg and 10% is 160-180 mmHg. CONCLUSIONS: This study provides an insight into the characteristics of a very old heart failure group with high comorbidity and mortality in a real situation. In agreement with previous studies, increasing age was associated with reduced likelihood of treatment particularly in ACE inhibitor and angiotensin receptor 1 blocker but this has been improved particularly in beta-blocker. There is a need to further improve education and application of guideline recommended medications for patients with heart failure for their well-being and survival.