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Previous Volume 328:971-975 April 1, 1993 Number 13 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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The Clinical Problem-Solving article "Too Old for What?" elsewhere in this issue¹ describes an 87-year-old woman with severe aortic stenosis, three-vessel coronary artery disease, depressed left ventricular function, and moderately severe heart failure. Once the diagnosis of aortic stenosis was made, neither the patient's physicians nor the discussant considered nonsurgical therapy, but in an accompanying note the editor wonders whether the discussion, which strongly favors surgery, might be too one-sided. Might the risks of surgery outweigh the expected benefit of symptomatic improvement? Should the possibility of improved life expectancy have a role in such decisions? How should the potential for . . . [Full Text of this Article]

Methods

Decision Model

Data Used in the Model

            Outcome of Aortic Stenosis with and without Surgery

            Mortality Associated with Surgery

            Morbidity Associated with Surgery

            Prognosis after Valve Replacement

            Quality of Life

            Attitudes toward Risk

Results

Sensitivity Analysis

Discussion

Source Information

New England Medical Center-Tufts University School of Medicine
Boston, MA 02111

Address reprint requests to Dr. Pauker at New England Medical Center, 750 Washington St., Boston, MA 02111.

References

This article has been cited by other articles:

• Hamel, M. B., Teno, J. M., Goldman, L., Lynn, J., Davis, R. B., Galanos, A. N., Desbiens, N., Connors, A. F. Jr., Wenger, N., Phillips, R. S., for the SUPPORT Investigators, (1999). Patient Age and Decisions To Withhold Life-Sustaining Treatments from Seriously Ill, Hospitalized Adults. ANN INTERN MED 130: 116-125 [Abstract] [Full Text]  
• Richardson, W. S., Detsky, A. S., the Evidence-Based Medicine Working Group, (1995). Users' Guides to the Medical Literature: VII. How to Use a Clinical Decision Analysis A. Are the Results of the Study Valid?. JAMA 273: 1292-1295 [Abstract]  
• Scharlach, A. E., Fredriksen, K. I. (1994). Elder Care Versus Adult Care: Does Care Recipient Age Make a Difference?. Research on Aging 16: 43-68 [Abstract]  
• Reich, J. S., Pauker, S. G., Thibault, G. E. (1993). Criticism of Clinical Problem-Solving. NEJM 329: 1743-1744 [Full Text]  
• Thibault, G. E. (1993). Too Old for What?. NEJM 328: 946-950 [Full Text]