Michael B. Rothberg, MD, MPH; Senthil K. Sivalingam, MD; Javed Ashraf, MD, MPH; Paul Visintainer, PhD; John Joelson, MD; Reva Kleppel, MSW, MPH; Neelima Vallurupalli, MD; Marc J. Schweiger, MD
It is unclear whether patients understand that percutaneous coronary intervention (PCI) reduces only chronic stable angina and not myocardial infarction (MI) or associated mortality.
To compare cardiologists' and patients' beliefs about PCI.
153 patients who consented to elective coronary catheterization and possible PCI, 10 interventional cardiologists, and 17 referring cardiologists.
Patients' and cardiologists' beliefs about benefits of PCI. All cardiologists reported beliefs about PCI for patients in hypothetical scenarios. Interventional cardiologists also reported beliefs for study patients who underwent PCI.
Of 153 patients, 68% had any angina, 42% had activity-limiting angina, 77% had a positive stress test result, and 29% had had previous MI. The 53 patients who underwent PCI were more likely than those who did not to have a positive stress test result, but angina was similar in both groups. Almost three quarters of patients thought that without PCI, they would probably have MI within 5 years, and 88% believed that PCI would reduce risk for MI. Patients were more likely than physicians to believe that PCI would prevent MI (prevalence ratio, 4.25 [95% CI, 2.31 to 7.79]) or fatal MI (prevalence ratio, 4.83 [CI, 2.23 to 10.46]). Patients were less likely than their physicians to report pre-PCI angina (prevalence ratio, 0.79 [CI, 0.67 to 0.92]). For the scenarios, 63% of cardiologists believed that the benefits of PCI were limited to symptom relief. Of cardiologists who identified no benefit of PCI in 2 scenarios, 43% indicated that they would still proceed with PCI in these cases.
The study was small and conducted at 1 center, and information about precatheterization counseling was limited.
Cardiologists' beliefs about PCI reflect trial results, but patients' beliefs do not. Discussions with patients before PCI should better explain anticipated benefits.
Rothberg MB, Sivalingam SK, Ashraf J, Visintainer P, Joelson J, Kleppel R, et al. Patients' and Cardiologists' Perceptions of the Benefits of Percutaneous Coronary Intervention for Stable Coronary Disease. Ann Intern Med. ;153:307–313. doi: 10.7326/0003-4819-153-5-201009070-00005
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Published: Ann Intern Med. 2010;153(5):307-313.
Cardiology, Coronary Heart Disease, Percutaneous Coronary Intervention.
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