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

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 cli...

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Autores principales: Hoxha, Ilir, Guda, Besim, Hoti, Ali, Zhubi, Esra, Selmani, Erza, Avdiu, Blerta, Cegllar, Jakob, Marušič, Dorjan, Osmani, Aferdita
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9690698/
https://www.ncbi.nlm.nih.gov/pubmed/36429362
http://dx.doi.org/10.3390/ijerph192214638
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author Hoxha, Ilir
Guda, Besim
Hoti, Ali
Zhubi, Esra
Selmani, Erza
Avdiu, Blerta
Cegllar, Jakob
Marušič, Dorjan
Osmani, Aferdita
author_facet Hoxha, Ilir
Guda, Besim
Hoti, Ali
Zhubi, Esra
Selmani, Erza
Avdiu, Blerta
Cegllar, Jakob
Marušič, Dorjan
Osmani, Aferdita
author_sort Hoxha, Ilir
collection PubMed
description 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), heart murmur (RRR, 0.57; CI 95%, 0.37–0.88), troponin levels (RRR, 0.59; CI 95%, 0.38–0.91), and NTproBNP levels (RRR, 0.36; CI 95%, 0.24–0.56). Conclusions: We often found odd and wide variations of clinical signs and examination results influencing the decision to diagnose a person with heart failure. It will be important to explore and understand these results better. The study findings are important for existing quality improvement support efforts and contribute to the standardization of clinical decision-making in the public hospitals in the country. This experience and this study can provide valuable impetus for further examination of these efforts and informing policy and development efforts in the standardization of care in the country.
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spelling pubmed-96906982022-11-25 Clinical Decision-Making for Heart Failure in Kosovo: A Conjoint Analysis Hoxha, Ilir Guda, Besim Hoti, Ali Zhubi, Esra Selmani, Erza Avdiu, Blerta Cegllar, Jakob Marušič, Dorjan Osmani, Aferdita Int J Environ Res Public Health Article 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), heart murmur (RRR, 0.57; CI 95%, 0.37–0.88), troponin levels (RRR, 0.59; CI 95%, 0.38–0.91), and NTproBNP levels (RRR, 0.36; CI 95%, 0.24–0.56). Conclusions: We often found odd and wide variations of clinical signs and examination results influencing the decision to diagnose a person with heart failure. It will be important to explore and understand these results better. The study findings are important for existing quality improvement support efforts and contribute to the standardization of clinical decision-making in the public hospitals in the country. This experience and this study can provide valuable impetus for further examination of these efforts and informing policy and development efforts in the standardization of care in the country. MDPI 2022-11-08 /pmc/articles/PMC9690698/ /pubmed/36429362 http://dx.doi.org/10.3390/ijerph192214638 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Hoxha, Ilir
Guda, Besim
Hoti, Ali
Zhubi, Esra
Selmani, Erza
Avdiu, Blerta
Cegllar, Jakob
Marušič, Dorjan
Osmani, Aferdita
Clinical Decision-Making for Heart Failure in Kosovo: A Conjoint Analysis
title Clinical Decision-Making for Heart Failure in Kosovo: A Conjoint Analysis
title_full Clinical Decision-Making for Heart Failure in Kosovo: A Conjoint Analysis
title_fullStr Clinical Decision-Making for Heart Failure in Kosovo: A Conjoint Analysis
title_full_unstemmed Clinical Decision-Making for Heart Failure in Kosovo: A Conjoint Analysis
title_short Clinical Decision-Making for Heart Failure in Kosovo: A Conjoint Analysis
title_sort clinical decision-making for heart failure in kosovo: a conjoint analysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9690698/
https://www.ncbi.nlm.nih.gov/pubmed/36429362
http://dx.doi.org/10.3390/ijerph192214638
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