Pulmonary vascular disease & thromboembolism
Evidence for Anchoring Bias During Physician Decision-Making
Authors' conclusion
In this cross-sectional study among patients with CHF presenting with SOB, physicians were less likely to test for PE when the patient visit reason that was documented before they saw the patient mentioned CHF.
Study context
- Population
- Patients with congestive heart failure (CHF) presenting with shortness of breath (SOB) to Veterans Affairs emergency department (EDs), 2011–20184.1% with CHF mention
- Participants
- 108,019 patients
- Exposure
- CHF mentioned vs not mentioned in triage visit reason
- Outcome
- PE testing (D-dimer, chest CT with contrast, ventilation/perfusion scan, lower-extremity ultrasonography), time to PE testing, BNP testing, acute PE diagnosed in the ED, acute PE ultimately diagnosed
- Follow-up
- Within 30 days of ED visit (ultimate PE diagnosis)
Methodological detailsnational Veterans Affairs data, Analyses performed July 2019 to January 2023
- National Veterans Affairs data
- Analyses performed July 2019 to January 2023
Main finding
As reported in the abstract
PE testing, time to PE testing, BNP testing, acute PE diagnosed in ED, acute PE ultimately diagnosed (within 30 days)
Mention of CHFDifference, pp (95% CI)
PE testing; adjusted
−4.6(−5.7 to −3.5)
BNP testing; adjusted
6.9(4.3–9.4)
PE diagnosis in ED
−0.15(−0.23 to −0.08)
Ultimately diagnosed PE; not significant
0.06(−0.23 to 0.36)
Mention of CHFDifference, minutes (95% CI)
Time to PE testing; adjusted
15.5(5.7–25.3)
- Overall pulmonary embolism (PE) testing
- 13.2%
- Overall time to PE testing (average)
- 76 minutes
- Overall BNP testing
- 71.4%
- Overall acute PE diagnosed in ED
- 0.23%
- Overall acute PE ultimately diagnosed
- 1.1%
Observational data: associations, not effects.
Original publication
Evidence for Anchoring Bias During Physician Decision-Making. JAMA Intern Med. Published 1 August 2023. doi:10.
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