Do Physicians' Attitudes toward Implantable Cardioverter Defibrillator Therapy Vary by Patient Age, Gender, or Race?
Do Physicians' Attitudes toward Implantable Cardioverter Defibrillator Therapy Vary by Patient Age, Gender, or Race?
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DOI：
10.1111/j.1542-474x.2010.00412.x
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发表时间：
2011-01-01
影响因子：
1.9
通讯作者：
Peterson, Eric
中科院分区：
文献类型：
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作者：
Al-Khatib, Sana M.;Sanders, Gillian D.;Peterson, Eric
方法：我们调查了随机样本（n = 9969）的美国医生谁是美国心脏病学会（ACC）的积极成员。我们询问了参与者在4种临床情况下推荐ICD治疗的可能性，这些临床情况随机改变了患者的年龄，性别，种族和ICD适应症（指南I类，IIa类，III类和I类不依从患者）。结果：收到了1210名医生的回复（回复率12%），其中1127名符合研究入选标准。应答者和无应答者具有相似的人口统计学特征。在对假设临床情景的反应中，医生不太可能向老年患者（>= 80岁vs 50岁）推荐ICD（P < 0.01），但所有类别适应症均不受性别或种族影响。与非电生理学家（EP）相比，EP更可能推荐ICD用于I类适应症（92.4% vs 81.4%; P < 0.01），但他们并不更有可能为III类适应症提供ICD（0.4% vs 0.6%; P = 0.95）。根据调查结果，医生同样愿意为男性和女性以及白人和黑人提供ICD，但即使在实践指南中指出，也不太可能为老年患者提供ICD。与非电生理学家相比，电生理学家（EP）更经常遵守ICD治疗的实践指南建议。Ann Noninvasive Electrocardiol 2011;16（1）：77-84.
Methods: We surveyed a random sample (n = 9969) of U.S. physicians who are active members of the American College of Cardiology (ACC). We asked participants about their likelihood to recommend ICD therapy in 4 clinical scenarios that randomly varied patient age, gender, race, and ICD indication (guideline Class I, Class IIa, Class III, and Class I in a noncompliant patient).Results: Responses were received from 1210 physicians (response rate 12%), of whom 1127 met the study inclusion criteria. Responders and nonresponders had similar demographics. In responding to hypothetical clinical scenarios, physicians were less likely to recommend an ICD to older patients (>= 80 vs 50 years) (P < 0.01) but were unaffected by gender or race for all class indications. Compared with nonelectrophysiologists (EPs), EPs were significantly more likely to recommend an ICD for a Class I indication (92.4% vs 81.4%; P < 0.01), but they were not more likely to offer an ICD for a Class III indication (0.4% vs 0.6%; P = 0.95).Conclusions: Based on survey responses, physicians were equally willing to offer an ICD to men and women and to whites and blacks, but were less likely to offer an ICD to an older patient even when indicated by practice guidelines. Electrophysiologists (EPs) more often adhered to practice guideline recommendations on ICD therapy compared with non-EPs. Ann Noninvasive Electrocardiol 2011;16(1):77-84.