Decision-making regarding medication for primary cardiovascular prevention

January 01, 0001

Decision-making regarding medication for primary cardiovascular prevention

Quality-assurance initiatives encourage adherence to evidenced-based guidelines based on a consideration of treatment benefit. These US authors examined older persons' willingness to take medication for primary cardiovascular disease prevention according to benefits and harms. They conducted in-person interviews with 356 community-living older persons. Participants were asked about their willingness to take medication for primary prevention of myocardial infarction (MI) with varying benefits in terms of absolute 5-year risk reduction and varying harms in terms of type and severity of adverse effects.

They found: "Most (88%) would take medication, providing an absolute benefit of 6 fewer persons with MI out of 100, approximating the average risk reduction of currently available medications. Of participants who would not take it, 17% changed their preference if the absolute benefit was increased to 10 fewer persons with MI, and, of participants who would take it, 82% remained willing if the absolute benefit was decreased to 3 fewer persons with MI. In contrast, large proportions (48%-69%) were unwilling or uncertain about taking medication with average benefit causing mild fatigue, nausea, or fuzzy thinking, and only 3% would take medication with adverse effects severe enough to affect functioning."

The authors concluded: "Older persons' willingness to take medication for primary cardiovascular disease prevention is relatively insensitive to its benefit but highly sensitive to its adverse effects. These results suggest that clinical guidelines and decisions about prescribing these medications to older persons need to place emphasis on both benefits and harms."

Guidelines should specifically take into account patient preferences.

For the full abstract, click here.

Arch Intern Med 171(10):923-928, 23 May 2011 © 2011 to the American Medical Association
Effects of Benefits and Harms on Older Persons' Willingness to Take Medication for Primary Cardiovascular Prevention. Terri R. Fried, Mary E. Tinetti, Virginia Towle, John R. O’Leary, Lynne Iannone.

Category: HSR. Health Services Research, K. Circulatory. Keywords: cardiovascular disease, myocardial infarction, primary prevention, medication, older persons, evidence-based guidelines, treatment harms, survey research, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 7 June 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.