Decision making in Ischemic cardiomyopathy: variability in physicians’ approaches and patients’ adherence

Resumen

Ischemic cardiomyopathy (ICM) is a common cardiovasculardisease with conflicting evidence regardingits management and a high risk profile for revascularizationprocedures that seems to have resulted invariable approach of physicians toward its management,and likewise, significant patient non-adherence to physicianrecommendation. We included patients with 3-vesseldisease and left ventricular ejection fraction (LVEF)<45%(ICM group; n=825), and patients with LM diseaseand LVEF ≥45% (LM group; n=162), detected by coronaryangiography at Tehran Heart Center. Variation of recommendationsamong cardiologists was evaluated. The rateof coronary artery bypass graft (CABG) non-adherencewas also determined, as well as its predictors and outcomein ICM group. Decision making was more variable inICM group, compared to LM group. CABG non-adherencewas significantly more common in ICM group (32.4%),compared to LM group (10.0%) (P<0.001). Advancedage, being female, absence of angina, creatinine >2mg/dl,severe left ventricular dysfunction, absence of LM diseaseand moderate or severe mitral regurgitation were predictorsof CABG non-adherence. ICM patients with CABGnon-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, revascularizationor hospitalization due to cardiac disease (HR: 1.94, 95%CI: 1.41-2.67), than those who received CABG. WhileICM is a common disorder encountered frequently in dailypractice of cardiologists, there is a significant variability indecision making, as well as a significant non-adherencetolifesaving recommendations for these patients.