Preference of individuals in the treatment strategies of acute myocardial infarction in China: a discrete choice experiment

Women's preferences for less active ectopic pregnancy treatment: A discrete choice experiment

RESEARCH QUESTION

Shared decision-making has become a hallmark of quality care and is increasingly spotlighted in practice guidelines. Little is known about women's views for treatment of less active ectopic pregnancy. What are the preferences of women for less active ectopic pregnancy treatment-related attributes?

DESIGN

A discrete choice model with 8 attributes depicting ectopic pregnancy treatment including varying levels of first-line treatment effectiveness, length of hospitalization, cost, length of sick leave, of convalescence, need for surgical management, for emergency care during convalescence and for tube removal was used. Childbearing aged women, i.e. those who might experience an ectopic pregnancy in the future, were recruited. They were asked to choose between hypothetical treatments in 18 choice tasks with different levels of all treatment attributes. A conditional logit McFadden's choice model was performed. The main outcome measure was preference weights for less active ectopic pregnancy treatment-related attributes.

RESULTS

A total of 5770 observations from 178 women were analysed. The attributes displaying the highest marginal impacts on women's decisions included: higher rate of first-line treatment effectiveness, lower rate of tube removal, lower rate of surgical management, shorter length of hospitalization and, to a lesser extent, but still significant, shorter length of convalescence, absence of risk of emergency care during convalescence and lower cost.

CONCLUSIONS

Trade-offs made by women between the attributes of less active ectopic pregnancy treatment suggest that no treatment option, either medical or surgical, is an obvious preferred option. These results encourage the promotion of shared decision-making.

The value of cardiac magnetic resonance post-contrast T1 mapping in improving the evaluation of myocardial infarction

Objective

To explore the additional value of cardiac magnetic resonance (CMR) post-contrast T1 mapping in the detection of myocardial infarction, compared with late gadolinium enhancement (LGE).

Materials and methods

A CMR database of consecutive patients with myocardial infarction was retrospectively analyzed. All patients were scanned at 3 T magnetic resonance; they underwent conventional CMR (including LGE) and post-contrast T1 mapping imaging. Two radiologists interpreted the CMR images using a 16-segment model. The first interpretation included only LGE images. After 30 days, the same radiologists performed a second analysis of random LGE images, with the addition of post-contrast T1 mapping images. Images were analyzed to diagnose myocardial scars, and the transmural extent of each scar was visually evaluated. Diagnoses retained after LGE were compared with diagnoses retained after the addition of post-contrast T1 mapping.

Results

In total, 80 patients (1,280 myocardial segments) were included in the final analysis. After the addition of post-contrast T1 mapping, eight previously unidentified subendocardial scars were detected. Compared with LGE images, the percentage of infarcted segments was higher after the addition of post-contrast T1 mapping images (21.7% vs. 22.3%, P = 0.008), the percentage of uncertain segments was lower after the addition of post-contrast T1 mapping (0.8% vs. 0.1%, P = 0.004), and the percentage of uncertain transmural extent of scarring was lower after the addition of post-contrast T1 mapping (0.9% vs. 0.1%, P = 0.001).

Conclusion

The addition of post-contrast T1 mapping after LGE helps to improve the detection of myocardial infarction, as well as the assessment of the transmural extent of scarring.

Preferences of Patients With Chronic Kidney Disease for Invasive Versus Conservative Treatment of Acute Coronary Syndrome: A Discrete Choice Experiment

Background Patients with chronic kidney disease (CKD) can experience acute coronary syndromes (ACS) with high morbidity and mortality. Early invasive management of ACS is recommended for most high-risk patients; however, choosing between an early invasive versus conservative management approach may be influenced by the unique risk of kidney failure for patients with CKD. Methods and Results This discrete choice experiment measured the preferences of patients with CKD for future cardiovascular events versus acute kidney injury and kidney failure following invasive heart procedures for ACS. The discrete choice experiment, consisting of 8 choice tasks, was administered to adult patients attending 2 CKD clinics in Calgary, Alberta. The part-worth utilities of each attribute were determined using multinomial logit models, and preference heterogeneity was explored using latent class analysis. A total of 140 patients completed the discrete choice experiment. The mean age of patients was 64 years, 52% were male, and mean estimated glomerular filtration rate was 37 mL/min per 1.73 m². Across the range of levels, risk of mortality was the most important attribute, followed by risk of end-stage kidney disease and risk of recurrent myocardial infarction. Latent class analysis identified 2 distinct preference groups. The largest group included 115 (83%) patients, who placed the greatest value on treatment benefits and expressed the strongest preference for reducing mortality. A second group of 25 (17%) patients was identified who were procedure averse and had a strong preference toward conservative management of ACS and avoiding acute kidney injury requiring dialysis. Conclusions The preferences of most patients with CKD for management of ACS were most influenced by lowering mortality. However, a distinct subgroup of patients was strongly averse to invasive management. This highlights the importance of clarifying patient preferences to ensure treatment decisions are aligned with patient values.

Preference of Virtual Reality Games in Psychological Pressure and Depression Treatment: Discrete Choice Experiment

BACKGROUND

Virtual reality (VR) can be used to build many different scenes aimed at reducing study-related stress. However, only few academic experiments on university students for preference testing have been performed.

OBJECTIVE

This study aims to assess the preference of VR games for stress and depression treatment using a discrete choice experiment (DCE).

METHODS

A total of 5 different attributes were selected based on the depression therapy parameters and attributes related to VR: (1) treatment modality; (2) therapy duration; (3) perceived remission rate; (4) probability of adverse events; and the (5) monthly cost of adding treatment to a discrete choice experiment. By comparing different attributes and levels, we could draw some conclusions about the depression therapy testing preference for university students; 1 university student was responsible for VR scene development and 1 for participant recruitment.

RESULTS

The utility value of different attributes for "0% Probability of adverse events" was higher than others (99.22), and the utility value of VR treatment as the most popular treatment method compared with counseling and medicine treatment was 80.95. Three parameter aspects (different treatments for depression) were statistically significant (P<.001), including "0%" and "50%" of "Probability of adverse events" and "¥500" (a currency exchange rate of ¥1 [Chinese yuan]=US $0.15 is applicable) of "The monthly cost of treatment." Most individuals preferred 12 months as the therapy duration, and the odds ratio of "12 months" was 1.095 (95% CI 0.945-1.270) when compared with the reference level (6 months). Meanwhile, the cheapest price (¥500) of depression therapy was the optimum choice for most students.

CONCLUSIONS

People placed great preference on VR technology psychological intervention methods, which indicates that VR may have a potential market in the treatment of psychological problems. However, adverse events and treatment costs need to be considered. This study can be used to guide policies that are relevant to the development of the application of VR technology in the field of psychological pressure and depression treatment.