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Decision Making in Ischemic Cardiomyopathy: Variability in Physicians' Approaches and Patients' Adherence



Bahremand M1 ; Ahmadinejad T2 ; Jenab Y2 ; Hoseini SK3 ; Lotfitokaldany M4 ; Jalali A5
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Authors Affiliations
  1. 1. Cardiology Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
  2. 2. Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Cardiology Department, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
  4. 4. Research Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Clinical Research Department, Tehran University of Medical Sciences, Tehran, Iran

Source: Revista Latinoamericana de Hipertension Published:2019

Abstract

schemic cardiomyopathy (ICM) is a common cardiovascular disease with conflicting evidence regarding its management and a high risk profile for revascularization procedures that seems to have resulted in variable approach of physicians toward its management, and likewise, significant patient non-adherence to physician recommendation. We included patients with 3-vessel disease and left ventricular ejection fraction (LVEF) <45%(ICM group; n=825), and patients with LM disease and LVEF ≥45% (LM group; n=162), detected by coronary angiography at Tehran Heart Center. Variation of recommendations among cardiologists was evaluated. The rate of coronary artery bypass graft (CABG) non-adherence was also determined, as well as its predictors and outcome in ICM group. Decision making was more variable in ICM group, compared to LM group. CABG non-adherence was significantly more common in ICM group (32.4%), compared to LM group (10.0%) (P<0.001). Advanced age, being female, absence of angina, creatinine >2mg/dl, severe left ventricular dysfunction, absence of LM disease and moderate or severe mitral regurgitation were predictors of CABG non-adherence. ICM patients with CABG non-adherence had significantly more all-cause mortality (Hazard Ratio [HR]: 1.97, 95% confidence interval [CI]: 1.28-3.04), and more all-cause mortality, revascularization or hospitalization due to cardiac disease (HR: 1.94, 95% CI: 1.41-2.67), than those who received CABG. While ICM is a common disorder encountered frequently in daily practice of cardiologists, there is a significant variability in decision making, as well as a significant non-adherenceto lifesaving recommendations for these patients. © 2019 Revista Latinoamericana de Hipertension. All rights reserved.