Saturday, April 2, 2005
Hall of Mirrors (Hilton Cincinnati Netherland Plaza)
Session: 1219, Poster Session I, 11:00 AM

Decision Making Characteristics and Preferences in Acute Myocardial Infarction Patients: Insights from PREMIER

Carole Decker, PhD, RN, Clinical Nurse Researcher1, Nina Worden, BA, Research Analyst2, Karen Nugent, BS, RRT, Research Coordinator2, Kimberly Reid, MS, Biostatistician2, and John Spertus, MD, MPH, Professor3. (1) Cardiovascular Research, Mid America Heart Institute & University of Missouri - Kansas City, 4401 Wornall Road, Kansas City, MO 64111, (2) Cardiovascular Research, Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, (3) Cardiovascular Research, Mid America Heart Institute & University of Missouri, 4401 Wornall Road, Kansas City, MO 64111

Purpose: The Institute of Medicine has challenged healthcare delivery to have patients be active in medical decision-making (MDM). We examined the frequency and characteristics with which Acute Myocardial Infarction (AMI) patients wish to assume an active role in decision making about their treatment.

Theoretical/Conceptual Framework: Informed consent is the standard in healthcare for decision making. Brody’s transparent conversation for informed consent serves as the Conceptual framework for the study.

Subjects: PREMIER, an observational registry, prospectively enrolled 2,502 AMI patients at 19 centers.

Method: Patients’ MDM preferences were quantified using a validated tool based on decision-making categories of: “doctor alone”, “mostly doctor”, to “share equally”, to “mostly patient (self)”, and “patient (self) alone”. An active role was defined as “mostly self”, “share equally”, and “self alone”, while passive was defined as “doctor alone” and “mostly doctor” along with a shared equally role. We examined demographic, clinical, patient, and baseline health status data as they related to MDM preferences using a multivariable logistic regression model.

Results & Conclusions: Overall, 69% of MI patients (n=1682/2448) responded they wanted an active role in making decisions. Multivariable model results illustrated the typical patient who wishes to have an active role is: younger (Odds Ratio 0.8 per 10 years, 95% CI 0.72 to 0.83, p<0.0001); more likely to be female (OR 1.6, 95% CI 1.33 to 1.99, p<0.0001); white (OR 1.5, 95% CI 1.19 to 1.90, p=0.0007); college educated (OR 1.9, 95% CI 1.56 to 2.28, p<0.0001); and more likely to live on the West Coast as opposed to the Midwest (OR 1.9, 1.34 to 2.69, p=0.012). There was no difference is decision making preference for patients with CHF, depression, or prior MI, PCI, or CABG. Preference for MDM was not associated with patients’ ultimate MI treatment (medical treatment vs. PCI vs. CABG).

Session #1219 - Poster Session I

The 29th Annual MNRS Research Conference (April 1-4, 2005)