Abstract
BackgroundPrior research reveals that processes and outcomes of cardiac care differ across sociodemographic strata. One potential contributing factor to such differences is the personality traits of individuals within these strata. We examined the association between risk-taking attitudes and cardiac patients' clinical and demographic characteristics, the likelihood of undergoing invasive cardiac procedures and survival.MethodsWe studied a large inception cohort of patients who underwent cardiac catheterization between July 1998 and December 2001. Detailed clinical and demographic data were collected at time of cardiac catheterization and through a mailed survey one year post-catheterization. The survey included three general risk attitude items from the Jackson Personality Inventory. Patients' (n = 6294) attitudes toward risk were categorized as risk-prone versus non-risk-prone and were assessed for associations with baseline clinical and demographic characteristics, treatment received (i.e., medical therapy, coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI)), and survival (to December 2005).Results2827 patients (45%) were categorized as risk-prone. Having risk-prone attitudes was associated with younger age (p < .001), male sex (p < .001), current smoking (p < .001) and higher household income (p < .001). Risk-prone patients were more likely to have CABG surgery in unadjusted (Odds Ratio [OR] = 1.21; 95% CI 1.08–1.36) and adjusted (OR = 1.18; 95% CI 1.02–1.36) models, but were no more likely to have PCI or any revascularization. Having risk-prone attitudes was associated with better survival in an unadjusted survival analysis (Hazard Ratio [HR] = 0.78 (95% CI 0.66–0.93), but not in a risk-adjusted analysis (HR = 0.92, 95% CI 0.77–1.10).ConclusionThese exploratory findings suggest that patient attitudes toward risk taking may contribute to some of the documented differences in use of invasive cardiac procedures. An awareness of these associations could help healthcare providers as they counsel patients regarding cardiac care decisions.
Highlights
Prior research reveals that processes and outcomes of cardiac care differ across sociodemographic strata
Specifications of Study Sample Among surveys sent to 11841 living patients with coronary artery disease (CAD) one year following their cardiac catheterization, 2891 did not respond, 141 were unable to complete, and 2391 did not wish to complete the survey
Using the date of cardiac catheterization as time zero in the survival analysis, we found that having risk-prone attitudes was associated with better survival over the follow up period, which for some patients was as long as 7.5 years
Summary
Prior research reveals that processes and outcomes of cardiac care differ across sociodemographic strata. Attitude toward risk-taking is a potentially interesting variable that could influence cardiac patients' preferences and approaches to decision-making, and in turn, be associated with their care and outcomes. Prosser and colleagues [23], for example, demonstrated that attitudes toward risk-taking were associated with the treatment decisions of patients with multiple sclerosis. Ayanian and Epstein [24] studied cardiac patients undergoing exercise testing to determine if potential gender differences risk-prone attitudes were associated with care decisions. They found that while there were no significant differences in the cardiac care decisions of men and women, men were more likely than women to have risk-prone attitudes. The investigators concluded that health researchers need to further explore the potential role of patients' attitudes about risk in decision-making around the use of coronary procedures
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