Short paperAge-related cognitive bias in in-hospital cardiac arrest
Introduction
Cognitive bias refers to systematic errors in reasoning including mental shortcuts (heuristics) that has been recognized as a potential source of medical error as it may affect clinical decision making.1 A recent study published in the New England Journal of Medicine explored this topic and found that patients with acute myocardial infarction who were admitted in the 2 weeks after their 80th birthday were significantly less likely to undergo coronary artery bypass grafting and had higher mortality compared to those admitted in the 2 weeks before their 80th birthday, suggesting the occurrence of cognitive bias, specifically left-digit bias.2 Left-digit bias refers to the concept of making decisions based only on the left digit, e.g. treating a 79-year old as “in their 70s” and a 80-year old as “in their 80s”. No study has explored whether left-digit bias exist in treatment of patients with an in-hospital cardiac arrest. Cognitive biases might be particularly prevalent in very acute conditions such as in-hospital cardiac arrest where decision-making is often rapid and based on limited information.
In this study, we utilized a regression discontinuity design to compare outcomes from in-hospital cardiac arrest in patients below and above specific age thresholds. The study was conducted to provide new insight into how cognitive bias may affect patient outcomes in in-hospital cardiac arrest.
Section snippets
Study design and data source
This was an observational study using data from the Get With The Guidelines®-Resuscitation (GWTG-R) registry. The GWTG-R is a prospective, quality-improvement registry of in-hospital cardiac arrest in the United States, sponsored by the American Heart Association. The registry has been described in detail elsewhere.3, 4, 5 Cardiac arrest is defined as a loss of pulse requiring chest compressions, defibrillation or both, with a hospital-wide or unit-based emergency response by acute care
Patient characteristics
There were 26,784 patients with an in-hospital cardiac arrest within three years below and above the age of 80 years (Fig. S1 in the Supplementary Content). Of these, 14,261 (53%) patients were between the age 77–80 years and 12,523 (47%) patients were between the age 80–83 years. Patient, event, and hospital characteristics are provided in Table S1 in the Supplementary Content.
Discontinuity threshold at age 80 years
The overall survival was 22% in patients with an in-hospital cardiac arrest at the age of 77–83 years. In the
Discussion
The presence of cognitive biases in decision-making was first described in the 1970s by Amos Tversky and Daniel Kahneman13 and popularized by Kahneman's 2011 book “Thinking, Fast and Slow”14. Although studies have explored cognitive biases in medical decision-making1, these studies have primarily focused on case-vignettes15, 16 and few have directly assessed patient-centered outcomes2, 17, 18. A specific type of cognitive bias is known as left-digit bias. The underlying assumption is that
Get With The Guidelines® – Resuscitation Investigators
Besides the author Ari Moskowitz, M.D., members of the Get With The Guidelines®-Resuscitation Adult Research Task Force include: Anne Grossestreuer PhD; Dana Edelson; MD MS; Joseph Ornato MD; Mary Ann Peberdy MD; Matthew Churpek MD MPH PhD; Michael Kurz MD MS-HES; Monique Anderson Starks MD MHS; Paul Chan MD MSc; Saket Girotra MBBS SM; Sarah Perman MD MSCE; and Zachary Goldberger MD MS.
Conflicts of interest and sources of funding
There are no disclosures. There was no specific funding for this study.
Authors’ contribution
Mathias J. Holmberg and Lars W. Andersen were responsible for the data acquisition, performed the statistical analyses, and drafted the manuscript. All authors contributed to the design of the study, interpreted the results, and critically revised the manuscript. All authors approved the final manuscript as submitted and agrees to be accountable for all aspects of the submitted work.
References (19)
- et al.
Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation
Resuscitation
(2003) - et al.
Duration of resuscitation efforts and survival after in-hospital cardiac arrest: an observational study
Lancet
(2012) - et al.
Regression discontinuity designs: a guide to practice
J Econom
(2008) - et al.
Memories of colonoscopy: a randomized trial
Pain
(2003) - et al.
Cognitive biases associated with medical decisions: a systematic review
BMC Med Inform Decis Mak
(2016) - et al.
Behavioral heuristics in coronary-artery bypass graft surgery
N Engl J Med
(2020) - et al.
First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults
JAMA
(2006) - et al.
Survival from in-hospital cardiac arrest during nights and weekends
JAMA
(2008) - et al.
Regression discontinuity designs in epidemiology: causal inference without randomized trials
Epidemiology
(2014)
Cited by (0)
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The members of the Get With The Guidelines-Resuscitation Adult Research Task Force are listed at the end of the article.