Decisions on statin therapy by patients' opinions about survival gains: cross sectional survey of general practitioners.

Peder A Halvorsen,Ivar Sønbø Kristiansen,Olaf Gjerløw Aasland

doi:10.1186/s12875-015-0288-8

Peder A Halvorsen, Ivar Sønbø Kristiansen + Show 1 more

Open Access

https://doi.org/10.1186/s12875-015-0288-8

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Abstract

BackgroundGuidelines for primary prevention of cardiovascular disease provide little guidance on how patients’ preferences should be taken into account. We wanted to explore whether general practitioners (GPs) are sensitive to patient preferences regarding survival gains from statin therapy.MethodsIn a cross sectional, online survey 3,270 Norwegian GPs were presented with a 55 year old patient with an unfavourable cardiovascular risk profile. He expressed preferences for statin therapy by indicating a minimum survival gain that would be considered a substantial benefit. This survival gain varied across six versions of the vignette: 8, 4 and 2 years, and 12, 6 and 3 months, respectively. Participants were randomly allocated to one version only. We asked whether the GPs would recommend the patient to take a statin. Subsequently we asked the GPs to estimate the average survival gain of life long simvastatin therapy for patients with a similar risk profile.ResultsWe received 1,296 responses (40 %). Across levels of survival gains (8 years to 3 months) the proportion of GPs recommending statin therapy did not vary significantly (OR per level 1.07, 95 % CI 0.99 to 1.16). The GP’s own estimate of survival gain was a statistically significant predictor of recommending therapy (OR per year adjusted for the GPs’ age, sex, speciality attainment and number of patients listed 3.07, CI 2.55 to 3.69).ConclusionGPs were insensitive to patient preferences regarding survival gain when recommending statin therapy. The GPs' recommendations were strongly associated with their own estimates of survival gain.

Highlights

Guidelines for primary prevention of cardiovascular disease provide little guidance on how patients’ preferences should be taken into account
We wanted to explore whether general practitioners (GPs) are sensitive to the patients’ preferences when considering statin
The respondents were fairly representative of Norwegian GPs with respect to age, sex (36 % females, Confidence interval (CI) 33 to 39) and number of patients listed, the total population of Norwegian GPs was slightly older and has slightly fewer patients listed

Summary

Introduction

Guidelines for primary prevention of cardiovascular disease provide little guidance on how patients’ preferences should be taken into account. We wanted to explore whether general practitioners (GPs) are sensitive to patient preferences regarding survival gains from statin therapy. The decision to initiate statin therapy for primary prevention of cardiovascular disease is a preference sensitive decision [2]. To facilitate shared decision making, conversations between doctors and patients should clarify the benefits and risks involved as well as patients’ values and preferences [3]. Studies of lay peoples’ hypothetical decisions suggest that they may find it Guidelines for primary prevention of cardiovascular disease provide tools for risk calculation and decision thresholds for preventive drug therapy [13], but there is not much guidance about how patients’ values and preferences should be taken into account. We wanted to explore whether general practitioners (GPs) are sensitive to the patients’ preferences when considering statin

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