A foreign older diabetic woman with an acute myocardial infarction: when cognitive biases in clinical decision-making become especially important

BMJ Case Rep. 2018 Feb 5:2018:bcr2017223135. doi: 10.1136/bcr-2017-223135.

Abstract

We present a case of an 80-year-old Turkish female patient with diabetes who suffered an acute myocardial infarction (AMI) and underwent percutaneous coronary balloon angioplasty (PTCA)/stenting. Due to new ischaemic episodes, a second PTCA/stenting had to be preformed 6 days later, which revealed a partial restent thrombosis. This case report raises several important issues. First, language problems are an important barrier for safety and quality in healthcare. Second, gender, ethnicity and age differences in patients with AMI need to be considered in order to eliminate inequities in clinical practice. Third, strategies to raise the awareness of cognitive biases as well as professional training about critical thinking and decision-making skills are needed.

Keywords: cardiovascular medicine; geriatric medicine; ischaemic heart disease.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Angioplasty, Balloon, Coronary
  • Anticoagulants / therapeutic use
  • Aspirin / therapeutic use
  • Clinical Decision-Making*
  • Communication Barriers*
  • Coronary Angiography
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diabetes Mellitus, Type 2 / therapy
  • Diabetic Angiopathies / diagnosis*
  • Diabetic Angiopathies / physiopathology
  • Diabetic Angiopathies / therapy
  • Female
  • Heparin / therapeutic use
  • Humans
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / physiopathology
  • Myocardial Infarction / therapy
  • Nitroglycerin / therapeutic use
  • Platelet Aggregation Inhibitors / therapeutic use
  • Reoperation
  • Treatment Outcome
  • Vasodilator Agents / therapeutic use

Substances

  • Anticoagulants
  • Platelet Aggregation Inhibitors
  • Vasodilator Agents
  • Heparin
  • Nitroglycerin
  • Aspirin