Abstract

BackgroundStatins and antihypertensive agents are recommended for primary prevention of cardiovascular disease (CVD), but they are not always prescribed to eligible patients.Design & settingA systematic review of qualitative studies.AimTo explore health professionals’ and patients’ attitudes towards cardiovascular preventive drugs.MethodMEDLINE, Embase, PsychINFO, CINAHL, ASSIA, HMIC, Conference Proceedings Citation Index, and Open Grey were searched for studies of qualitative design without restrictions on date or language. Two reviewers performed study selection, data extraction, quality assessment, and thematic synthesis.ResultsIn total, 2585 titles and abstracts were screened, yielding 27 studies, of which five met eligibility criteria on full text assessment. These included 62 patients and 47 health professionals. Five themes emerged about patient attitudes: questioning preventive drugs; perceived benefit and risks, such as improving quality of life; patient preferences; trust in health professional judgement; and family, friends, and media influences. Five themes emerged about health professional attitudes: addressing patient concerns and information; duty as a health professional to prescribe; uncertainty about preventive drug prescribing; recognising consequences of prescribing, such as unnecessary medicalisation; and personalised treatment.ConclusionThe attitudes of patients and health professionals regarding drug initiation for primary prevention reflect the complexity of the patient–health professional encounter in primary practice. For prescribing to be more adherent to guidelines, research should further investigate the patient–health professional relationship and the appropriate communication methods required when discussing drug initiation, specifically for primary prevention.

Highlights

  • cardiovascular disease (CVD) is the leading cause of death worldwide.[1]

  • The attitudes of patients and health professionals regarding drug initiation for primary prevention reflect the complexity of the patient–health professional encounter in primary practice

  • This review explored the attitudes towards preventive drugs from both the patients' and health professionals' perspectives

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Summary

Introduction

CVD is the leading cause of death worldwide.[1]. Statins for primary prevention of CVD reduce the risk of cardiovascular events by 25%.2–4 The use of antihypertensive drugs to lower blood pressure in patients with systolic blood pressure ≥140 mmHg is associated with a reduction in major cardiovascular events by 12%.5 The National Institute for Health and Care Excellence (NICE) recommends statins for primary prevention of CVD in patients with a 10-y­ear CVD risk of ≥10%.6 NICE recommends antihypertensive drugs for patients

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