Quality Indicators for the Care of Ischemic Heart Disease in Vulnerable Elders

Published in: Journal of the American Geriatrics Society, v. 55, no. S2, Oct. 2007, p. S366-S372

Posted on RAND.org on January 01, 2007

by Karol E. Watson, Constance Fung, Matthew J. Budoff

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Advanced age remains a strong, independent predictor of mortality from ischemic heart disease (IHD), even when controlling for other risk factors. Despite the availability of many therapies that are of proven benefit in reducing mortality and improving clinical outcomes in older patients with IHD, these treatments remain substantially underused. Advanced age also increases the risk of complications from therapies aimed at preventing cardiac death. Thus, a delicate balance must be struck when deciding which therapies will provide overall benefit. This article investigates quality indicators (QIs) that could be applied when treating vulnerable elders (VE) for IHD and review the available data in support of each of these indicators. METHODS: A total of 367 articles were considered in this review: 46 identified through a Web search, 118 through reference mining, and 203 through the Assessing Care of Vulnerable Elders (ACOVE)-3 literature searches. RESULTS: Of the 21 potential QIs, the expert panel process judged 17 to be valid, three were rejected, and two were combined. One QI was added from Quality Indicators for Screening and Prevention in Vulnerable Elders. The literature that supports each of the indicators judged to be valid in the expert panel process is described.

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