Nav: Home

Physicians and patients overestimate risk of death from acute coronary syndrome

March 10, 2015

WASHINGTON - Both physicians and patients overestimate the risk of heart attack or death for possible acute coronary syndrome (ACS) as well as the potential benefit of hospital admission for possible ACS. A survey of patient and physician communication and risk assessment, along with an editorial, were published online last week in Annals of Emergency Medicine ("Quantifying Patient-Physician Communication and Perceptions of Risk During Admissions for Possible Acute Coronary Syndromes" and "Lost in Translation: Physician Understanding and Communication of Risk to Patients with Possible Acute Coronary Syndrome is Unacceptable and in Dire Need of Resuscitation").

"Even immediately after the patient and doctor discuss the reasons for hospital admission, it turns out we're disagreeing about those reasons two-thirds of the time," said lead study author David Newman, MD, of the Icahn School of Medicine at Mount Sinai in New York, N.Y. "In many ways, it seems almost like we're ships passing in the night. To us, what this suggests is that patient-doctor communication is largely ineffective, and that a costly and potentially burdensome decision--admission to the hospital--is being made without patients understanding 'why', and thus without being able to participate in that decision."

Of patients who were admitted to the hospital from the emergency department with possible ACS, 65 percent reported discussing their risk of myocardial infarction (heart attack) with their physicians, while physicians reported such discussions occurred with only 46 percent of patients. Following discussion with their physicians, patients' assessment of their risk of heart attack remained the same or increased.

There was a huge disparity between patients and physicians about their relative risk of heart attack at home (versus the hospital). Patients assessed mortality risk from heart attack at 80 percent if they were sent home, but only 10 percent if they were admitted to the hospital. Physicians estimated those risks at 15 percent if sent home and 10 percent if admitted to the hospital.

An editorial accompanying the study speculates that numerous concerns, including fears of liability, guide decision-making in patients with possible ACS.

"What is concerning here is that the actual average risk of death or heart attack within 30 days was less than 2 percent," said the author of the editorial, Erik P. Hess, MD, MSc, of the Mayo Clinic in Rochester, Minn. "Risk communication in the ER is far from straightforward and physicians and patients may have very different ideas of what constitutes 'low risk.' That said, we have to do a better job of telling our patients the facts without inflating either their hopes or their fears."

Misperceptions of risks and benefits of a wide variety of medical screenings and interventions have been a focus of study in recent years as the health care system struggles to ratchet down costs and improve outcomes. Emergency physicians have long advocated for the development of clinical practice guidelines as a way to decrease testing and admissions that are ordered, in part, as a hedge against being sued.
-end-
Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information, visit http://www.acep.org.

American College of Emergency Physicians

Related Heart Attack Articles:

Heart cells respond to heart attack and increase the chance of survival
The heart of humans and mice does not completely recover after a heart attack.
A simple method to improve heart-attack repair using stem cell-derived heart muscle cells
The heart cannot regenerate muscle after a heart attack, and this can lead to lethal heart failure.
Mount Sinai discovers placental stem cells that can regenerate heart after heart attack
Study identifies new stem cell type that can significantly improve cardiac function.
Fixing a broken heart: Exploring new ways to heal damage after a heart attack
The days immediately following a heart attack are critical for survivors' longevity and long-term healing of tissue.
Heart patch could limit muscle damage in heart attack aftermath
Guided by computer simulations, an international team of researchers has developed an adhesive patch that can provide support for damaged heart tissue, potentially reducing the stretching of heart muscle that's common after a heart attack.
More Heart Attack News and Heart Attack Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Erasing The Stigma
Many of us either cope with mental illness or know someone who does. But we still have a hard time talking about it. This hour, TED speakers explore ways to push past — and even erase — the stigma. Guests include musician and comedian Jordan Raskopoulos, neuroscientist and psychiatrist Thomas Insel, psychiatrist Dixon Chibanda, anxiety and depression researcher Olivia Remes, and entrepreneur Sangu Delle.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...