Abstract: SA-PO884
Treatment Preferences of Patients with CKD in Acute Coronary Syndrome: A Discrete Choice Experiment
Session Information
- CKD: Pharmacoepidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Wilson, Todd, University of Calgary, Calgary, Alberta, Canada
- Hazlewood, Glen, University of Calgary, Calgary, Alberta, Canada
- Wilton, Stephen B., University of Calgary, Calgary, Alberta, Canada
- Sajobi, Tolulope, University of Calgary, Calgary, Alberta, Canada
- Amin javaheri, Pantea, University of Calgary, Calgary, Alberta, Canada
- Finlay, Juli, University of Calgary, Calgary, Alberta, Canada
- Pearson, Winnifred (winnie) E., Alberta Health Services, CALGARY, Alberta, Canada
- Connolly, Carol, Can-SOLVE CKD Network, Calgary, Alberta, Canada
- James, Matthew T., University of Calgary, Calgary, Alberta, Canada
Group or Team Name
- Alberta Provincial Program for Outcome Assessment in Coronary Heart Disease (APPROACH) and Can-SOLVE CKD Network project team
Background
Chronic kidney disease (CKD) is associated with a high incidence of acute coronary syndrome (ACS) and related morbidity and mortality. Treatment choices for patients with CKD involve tradeoffs in potential benefits and harms of invasive management options.
Methods
To design, pilot and field a discrete choice experiment (DCE) to quantify preferences of patients with CKD towards invasive heart procedures. Attributes of invasive versus conservative treatment for ACS were identified through semi-structured qualitative interviews. Levels for each attribute were determined from CKD subgroup analyses of early invasive versus conservative management clinical trials and cohort studies. The DCE was co-developed with physicians and patient input. Eligible patients for the study included those with CKD over 18 years of age, recruited from two multidisciplinary CKD clinics in Calgary, Alberta. Patients were recruited for the pilot study from September to November 2018 and the full study commenced in January 2019. Average importances for treatment attributes were quantified using Hierarchical Bayes estimation, and scaled on a 0-100 scale to reflect their relative importance.
Results
Among 64 patients who provided consent to participate in this full study, 59 (92%) completed the survey. Participants had an average age of 67 years, with 41% female, and mean eGFR 18mL/in/1.73m2.The most important attributes were risk of death within one-year (32.0, 95% CI [28,6, 35.4]) and end stage renal disease (20.5, 95% CI [17.3, 23.7]). The attributes AKI requiring dialysis, risk of another heart attack within one year and invasive procedures (versus conservative management) were of lesser importance (17.2, 95% CI (14.8, 19.7); 15.8, 95% CI (14.2, 17.5); and 14.5 95% CI (11.0, 18.0), respectively).
Conclusion
These results demonstrate the feasibility of conducting a DCE to quantify preferences of patients with CKD. Preliminary findings suggest patients with CKD are most risk averse towards death, however, end-stage kidney disease is a strong consideration. Measurement of these patient preferences can be used to inform the strength of clinical guideline recommendations and to improve shared-decision making approaches for cardiovascular disease for patients with CKD.
Funding
- Private Foundation Support