Clinical Decision-Making for Heart Failure in Kosovo: A Conjoint Analysis

作者：Ilir Hoxha, Besim Guda, Ali Hoti, Esra Zhubi, Erza Selmani, Blerta Avdiu, Jakob Cegllar, Dorjan Marušič, Aferdita Osmani · 发表于：International Journal of Environmental Research and Public Health · 年份：2022 · DOI：10.3390/ijerph192214638 · 被引用次数：3 · 研究领域：Heart Failure Treatment and Management、Health Systems, Economic Evaluations, Quality of Life、Cardiac pacing and defibrillation studies

BACKGROUND: Heart failure represents a life-threatening progressive condition. Early diagnosis and adherence to clinical guidelines are associated with improved outcomes for patients with heart failure. However, adherence to clinical guidelines remains limited in Kosovo. OBJECTIVE: To assess the clinical decision-making related to heart failure diagnosis by evaluating clinicians' preferences for clinical attributes. METHOD: Conjoint analysis with 33 clinical scenarios with physicians employed in public hospitals in Kosovo. SETTING: Two public hospitals in Kosovo that benefited from quality improvement intervention. PARTICIPANTS: 14 physicians (internists and cardiologists) in two hospitals in Kosovo. OUTCOME MEASURES: The primary outcome was the overall effect of clinical attributes on the decision for heart failure diagnosis. RESULTS: When considering clinical signs, the likelihood of a heart failure diagnosis increased for ages between 60 to 69 years old (RRR, 1.88; CI 95%, 1.05-3.34) and a stable heart rate (RRR, 1.93; CI 95%, 1.05-3.55) and decreased for the presence of edema (RRR, 0.23; CI 95%, 0.15-0.36), orthopnea (RRR, 0.31; CI 95%, 0.20-0.48), and unusual fatigue (RRR, 0.61; CI 95%, 0.39-0.94). When considering clinical examination findings, the likelihood for heart failure diagnosis decreased for high jugular venous pressure (RRR, 0.49; CI 95%, 0.32-0.76), pleural effusion (RRR, 0.35; CI 95%, 0.23-0.54), hearing third heart sound, (RRR, 0.50; CI 95%, 0.33-0.77), hea...