The HEart iN Renal dIsease (HENRI) study V1.0
Research type
Research Study
Full title
Treatment decision-making in myocardial infarction for people with advanced kidney disease: A qualitative study.
IRAS ID
297507
Contact name
Jemima Scott
Contact email
Sponsor organisation
University of Bristol
Duration of Study in the UK
1 years, 6 months, 26 days
Research summary
Research Summary:
: Previous studies have shown that people with kidney disease are less likely to be treated ‘aggressively’ after a heart attack, than those without kidney disease. They are less likely to have an angiogram, stent or a bypass operation. Most modern treatment guidelines suggest that we should use the same treatments for heart attacks in people with and without kidney disease. We therefore wanted to understand why these treatment differences exist.
To do this, we interviewed doctors and patients from across the United Kingdom (2022-2024), and asked them how they made heart attack treatment decisions. We chose 32 doctors from a range of specialties (kidney doctors, heart specialists, emergency department doctors) and levels of seniority. We also spoke to 14 patients of different age, gender and severity of kidney disease. Some of these individuals used dialysis or had a kidney transplant, as their own kidneys had failed. Each interview lasted about 45 minutes and took place face-to-face, by telephone or on-line, as suited the participants.
We found that despite holding strong opinions about how they would like to be treated, patients reported little involvement in heart attack treatment decision-making within hospitals. Doctors made most of the decisions. Many doctors said their priority was to avoid causing harm to people with kidney disease, from the side effects of heart attack treatments. They were worried about worsening kidney function and bleeding. Some felt that, whilst patients could come from harm from their heart attack if under-treated, this was less the fault of the doctor, than harm from the side effects of treatment. Doctors described lack of confidence in written guidelines. This was particularly true if they had seen a bad treatment outcome in a person with kidney disease previously. Overall, doctors who felt supported by other specialists (kidney doctors or heart specialists) described feeling able to make more ‘aggressive’ treatment decisions for people with kidney disease. Those working without the support of other doctors described making more cautious decisions, for example avoiding angiograms and stents.
In summary, this UK study suggested that designing systems to encourage heart, kidney and medical doctors to work together to make heart attack treatment decisions for high-risk patients, may reduce the heart attack treatment gap between people with and without kidney disease.
Aims:
To understand how heart attack treatment decisions are made for, and by, people with kidney disease.
Background:
Kidney disease is common. In the UK kidney disease affects one in six people. People with kidney disease die, on average, at a younger age than those without kidney disease. Heart attacks are one of the most common causes of death in this population.
In the UK, one person suffers a heart attack every five minutes. Up to one in three will have kidney disease. There have been major advances in heart attack treatment over the past 50 years, and “gold-standard” (best practice) treatments now include a cocktail of medications as well as procedures to improve the blood supply to the heart. As a result of these advances, six out of seven people will now be alive one year after their heart attack. Only one in two people with kidney disease will however survive this long.
We do not know why people with kidney disease have such poor survival after heart attack. Previous research has shown that they are less likely to receive “gold standard” treatments for heart attack than those without kidney disease. We believe that if more people with kidney disease received these treatments, fewer people might die. It is important that we understand how and why treatment decisions are made for people with kidney disease, so we can learn how we can improve their heart attack care.
Methods:
We will interview clinical staff and people with kidney disease to understand their experiences and opinions about giving and receiving heart attack care. Participants will have a single one-on-one conversation with a researcher, in a place of their choosing.
This study is funded by the National Institute for Health Research. Participants will be recruited from between three and five hospital sites.
REC name
South West - Cornwall & Plymouth Research Ethics Committee
REC reference
21/SW/0162
Date of REC Opinion
8 Dec 2021
REC opinion
Further Information Favourable Opinion