ACC 2016: Angiography CAD patients prefer more invasive procedures, underestimate risks

April 4, 2016 – Only 6 percent of patients said they preferred their physician to make treatment decisions alone.

When asked for their preferences, many coronary artery disease (CAD) patients prefer more invasive measures over medical therapy. However, these patients also tend to underestimate the risk of complications associated with invasive procedures.

That is the finding of a new study led by the DCRI’s Jacob Doll, MD (pictured). The study was presented in a poster session Monday at the annual Scientific Sessions of the American College of Cardiology in Chicago.

Although current guidelines recommend shared decision-making between CAD patients and clinicians when deciding on a course of treatment, decisions about revascularization are often made during coronary angiography when patients are sedated and unable to participate.

“In many cases, there’s not a clear right answer for what is the best treatment for a patient,” Doll said. “That’s why it’s important to have a discussion of the risks and benefits of each possible procedure.”

Earlier research on ambulatory patients with CAD suggested that patients demonstrate a greater preference for medical management compared with percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). In this study, Doll and his colleagues wanted to explore the preferences of CAD patients undergoing coronary angiography.

They surveyed 98 patients prior to angiography between November 2014 and March 2015. The researchers surveyed patients about who should make decisions, how they would like to be treated if given a choice, and their estimate of PCI and CABG complication rates.

The survey respondents included both inpatients and outpatients. The median age of subjects was 64 years, 66 percent were male, and 71 percent were white. The indication for angiography was stable angina in 28 percent, unstable angina in 34 percent, non-ST segment elevation myocardial infarction in 16 percent, and atypical symptoms in 21 percent.

Eighty-five percent of patients preferred some form of shared decision making, with 9 percent wanting to make the decision independently, and only 6 percent preferring the physician make the treatment decision alone. Most patients said they would prefer PCI to medical therapy alone or CABG if they were offered a choice by their physician.

Doll said the findings were somewhat surprising, as patients generally prefer less invasive treatment.

“These results may be connected to the setting of this particular study,” he said. “The patients are already undergoing an invasive procedure with the angiography, so they may be more open to invasive therapies than they would be otherwise.”

Most patients also underestimated the risk of major complications (death, heart attack, or stroke) associated with PCI (70 percent) and CABG (91 percent), when compared with literature-based estimates. Doll attributed this finding to patients’ limited information about these procedures.

“There’s not a lot of knowledge out there,” he said. “It’s not obvious how risky some of these therapies really are.”

In addition to Doll, the study’s other Duke authors included Rohan Shah, W. Schuyler Jones, MD, and Manesh Patel, MD.