Patients were significantly more likely than physicians to believe that percutaneous coronary intervention would prevent myocardial infarction (prevalence ratio 4.25; 95% CI 2.31-7.79).
Cross-Sectional (n=180)
No
Do patients and cardiologists have differing beliefs regarding the benefits of PCI for stable coronary disease?
There is a significant disconnect between patients and cardiologists regarding the expected benefits of PCI for stable coronary disease, with patients largely overestimating its ability to prevent MI and death.
Relative Risk: 4.25 (95% CI 2.31–7.79)
BACKGROUND: It is unclear whether patients understand that percutaneous coronary intervention (PCI) reduces only chronic stable angina and not myocardial infarction (MI) or associated mortality. OBJECTIVE: To compare cardiologists' and patients' beliefs about PCI. DESIGN: Survey. SETTING: Academic center. PARTICIPANTS: 153 patients who consented to elective coronary catheterization and possible PCI, 10 interventional cardiologists, and 17 referring cardiologists. MEASUREMENTS: 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. RESULTS: 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. LIMITATION: The study was small and conducted at 1 center, and information about precatheterization counseling was limited. CONCLUSION: Cardiologists' beliefs about PCI reflect trial results, but patients' beliefs do not. Discussions with patients before PCI should better explain anticipated benefits. PRIMARY FUNDING SOURCE: None.
Michael B. Rothberg (2010) conducted a cross-sectional in Stable Coronary Disease (n=180). Patient status vs. Physicians was evaluated on Belief that PCI would prevent MI (prevalence ratio 4.25, 95% CI 2.31 to 7.79). Patients were significantly more likely than physicians to believe that percutaneous coronary intervention would prevent myocardial infarction (prevalence ratio 4.25; 95% CI 2.31-7.79).