Perspectives on Why Patients with Mild Cognitive Impairment Might Receive Fewer Cardiovascular Disease Treatments than Patients with Normal Cognition.
Perspectives on Why Patients with Mild Cognitive Impairment Might Receive Fewer Cardiovascular Disease Treatments than Patients with Normal Cognition.
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DOI：
10.3233/jad-220495
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发表时间：
2023
影响因子：
4
通讯作者：
Levine, Deborah A.
中科院分区：
文献类型：
--
作者：
Blair, Emilie M.;Reale, Bailey K.;Zahuranec, Darin B.;Forman, Jane;Langa, Kenneth M.;Giordani, Bruno;Fagerlin, Angela;Kollman, Colleen;Whitney, Rachael T.;Levine, Deborah A.
轻度认知障碍（MCI）患者接受的心血管疾病（CVD）指南一致性治疗少于认知正常（NC）患者。了解医生对MCI患者接受CVD治疗少于NC患者的原因的看法。作为评估患者MCI如何影响医生对急性心肌梗死（AMI）和卒中治疗决策的混合方法研究的一部分，我们使用来自三个专业的医生的半结构化访谈进行了描述性定性研究。主题包括参与者对医生向MCI患者推荐较少CVD治疗的数据的反应，以及参与者认为可能向该患者人群推荐较少CVD治疗的原因。参与者包括22名医生（8名心脏病专家、7名神经科医生和7名初级保健医生）。大多数人认为MCI患者的CVD治疗不足是不合理的，而一些参与者认为这可以被认为是合理的。参与者推测，其他医生可能持有的信念，可能是对MCI患者心血管疾病治疗不足的原因。这些信念分为四个主要类别：1）MCI患者的病情比NC更严重，2）MCI患者的治疗并发症风险更高，3）患者的认知障碍可能会阻碍他们同意或坚持治疗的能力，以及4）MCI患者从治疗中获益少于NC。这些发现表明，大多数医生认为，建议MCI患者的CVD治疗少于NC患者是不合理的。提高医生对MCI的理解可能有助于减少MCI患者CVD治疗的差异。
People with mild cognitive impairment (MCI) receive fewer guideline-concordant treatments for cardiovascular disease (CVD) than people with normal cognition (NC). To understand physician perspectives on why patients with MCI receive fewer CVD treatments than patients with NC. As part of a mixed-methods study assessing how patient MCI influences physicians’ decision making for acute myocardial infarction (AMI) and stroke treatments, we conducted a descriptive qualitative study using semi-structured interviews of physicians from three specialties. Topics included participants’ reactions to data that physicians recommend fewer CVD treatments to patients with MCI and reasons why participants think fewer CVD treatments may be recommended to this patient population. Participants included 22 physicians (8 cardiologists, 7 neurologists, and 7 primary care physicians). Most found undertreatment of CVD in patients with MCI unreasonable, while some participants thought it could be considered reasonable. Participants postulated that other physicians might hold beliefs that could be reasons for undertreating CVD in patients with MCI. These beliefs fell into four main categories: 1) patients with MCI have worse prognoses than NC, 2) patients with MCI are at higher risk of treatment complications, 3) patients’ cognitive impairment might hinder their ability to consent or adhere to treatment, and 4) patients with MCI benefit less from treatments than NC. These findings suggest that most physicians do not think it is reasonable to recommend less CVD treatment to patients with MCI than to patients with NC. Improving physician understanding of MCI might help diminish disparities in CVD treatment among patients with MCI.