Author + information
- Mohammad Amin Kashef,
- Laura Scherer,
- Brian Zikmund-Fisher,
- Megan Coylewright,
- Henry H. Ting and
- Michael B. Rothberg
Contrary to clinical trial evidence, most patients with stable coronary artery disease (CAD) believe that percutaneous coronary intervention (PCI) prevents myocardial infarction (MI). We explored subjects’ willingness to accept hypothetical PCI depending on how information was presented.
Individuals aged ≥50 years (n=1600) were recruited for a web-based survey. Participants were asked to read 1 of 4 hypothetical scenarios and complete a questionnaire. In all scenarios participants were asked to imagine visiting a cardiologist after experiencing chest pain and having a positive stress test. In the first 3 scenarios, CAD was described in terms of artery blockage. In the first, there was no mention of the effects of PCI on MI risk. In the second, individuals were specifically told that PCI does not reduce MI risk. In the third, individuals were told why PCI does not reduce MI risk. In the fourth, CAD was described as artery inflammation. All scenarios included information about PCI complications, the role of PCI in reducing angina, and the benefits of medical therapy. Subjects were then asked if they would undergo PCI and take medicine, and how effective PCI or medical therapy were for preventing MI. Data were analyzed by ANOVA.
When given no information about the effect of PCI on MI risk, subjects were more likely to choose PCI (69 % vs. 40-50 % when told PCI does not reduce risk, P<0.001) and to believe that PCI prevents MI (71% vs. 31-39%, P<0.001), and less likely to agree to take medication (83% vs. 87%-92%; P<0.001). Subjects given no information thought PCI was more effective than medication; the rest thought the opposite. The choice to undergo PCI was strongly correlated to the belief that PCI prevents MI (R=0.50) and less so to the extent that symptoms limited activity (R=0.17). Subjects were more likely to perceive a lesion as an “immediate and severe threat to life” if it was described as “95% blockage” than if it was described as “CAD”.
In the absence of information to the contrary, most patients will assume that PCI prevents MI in stable CAD. Explicit information can partially overcome that bias and influence decision-making.
West, Room 3014
Saturday, March 09, 2013, 8:00 a.m.-8:15 a.m.
Session Title: The Cutting Edge in Revascularization for SIHD
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 910-3
- 2013 American College of Cardiology Foundation