Patients often overestimate PCI benefits
MedWire News: US researchers report that patients with angina often overestimate the benefits of percutaneous coronary intervention (PCI).
The majority of these patients believe that undergoing PCI will reduce their risk for death and myocardial infarction (MI), when in fact "the established benefits of PCI are limited to relief of angina and improved quality of life for up to 3 years," explain Michael Rothberg (Baystate Medical Center, Springfield, Massachusetts) and team.
They note however that "in contrast to their patients, the cardiologists generally acknowledged the limitations of PCI."
Rothberg and colleagues initially hypothesized that patients' "beliefs about the necessity of the procedure and its efficacy are likely to be shaped by their interaction with their physicians."
To investigate, the team sent patient-specific surveys to 153 angina patients who consented to elective coronary catheterization with possible PCI. Patients were asked questions about the type and severity of their angina, their source and extent of knowledge about PCI, and their personal expectations of the procedure.
A patient-specific survey was also sent to the 10 interventional cardiologists who performed the PCI procedure, in addition to a general survey that was also sent to the 17 cardiologists who initially referred the patients for PCI. These surveys gauged the cardiologists' beliefs about the consent procedure, decision making process, and benefits of PCI.
The findings, published in the Annals of Internal Medicine, showed that 63% of all cardiologists believed that PCI benefits were solely limited to symptom relief. Of note, 70% of cardiologists identified fictional patient-specific scenarios with no benefit of proceeding to PCI, 43% of these however, indicated that they would still go ahead with the procedure in these cases.
In all, 53 patients underwent PCI, but the rate of angina among these patients was similar to the 100 patients who did not undergo PCI, at 75.5% versus 64.7% (p=0.20).
Interestingly, 85% of patients who underwent PCI believed it would prevent a future MI but only 17% of their cardiologists shared this belief. Similarly, 66% of patients who had the procedure believed it would reduce their overall mortality risk while only 22% of their cardiologists expressed this belief.
In general, the expectations of patients who underwent PCI were similar to those who did not, and the interventional and referring cardiologists appeared to agree on the benefits of PCI.
In a related commentary, Alicia Fernandez (University of California, San Francisco) hypothesized that the noted patient-physician discrepancies may have resulted for many reasons such as if "physicians told the patients that PCI could reduce chest pain and the patients made the understandable leap that this would also mean a reduction in MI and death."
Rothberg and colleagues conclude that the findings of this study indicate that "further efforts should be directed toward improving communication of medical evidence to help patients make informed decisions about this common procedure."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Lauretta Ihonor