Such are the findings from a study published in the September Annals of Internal Medicine. The study examines the beliefs of patients with stable coronary artery disease who agreed to undergo elective angioplasty (PCI). Specifically, the study contrasts the patients’ understanding of the benefits of the procedure with those that the patient’s referring cardiologist or the Interventional Cardiologist believed they had told the patients.
The patient population consisted of 158 patients with stable heart disease. Of these patients, 68% had angina, 42% had activity-limiting angina, 77% had a positive stress test result, and 29% had had previous heart attack (MI). Almost three quarters of patients thought that without the procedure (PCI), they would probably have MI within 5 years, and 88% believed that PCI would reduce risk for an MI.
In contrast, 63% of cardiologists believed that the benefits of PCI were limited to symptom relief of angina-related pain. Opening up blocked coronary arteries can be life-saving in emergencies, but there is no evidence that increasing blood flow to the heart in stable patients prevents future heart attacks as patient believed.
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The study did not looking at the appropriateness of care. It simply considered whether patients heard what physicians think they told them in the office when discussing the risks and benefits of have the procedure.
The Upshot of the Study?
The study, and others like it, point to the need for:
- More Informed Decision Making – this study suggests that patients are not getting (from their physicians) or do not understand the information they need to make informed decisions about potentially hazardous procedures.
- Better Understanding of the Patient Beliefs – Patients may stop taking medications in the mistaken belief that they are no longer at risk due to having had angioplasty.
- The Need Engage in “Teach Back” Methods with Patients – Physicians need to get patients to repeat what they to believe their physician told them to insure greater accuracy.
Authors cautioned that the “communication gap” identified in the study is probably not limited to angioplasty and may apply to many potentially dangerous and costly treatments and procedures.
Rothberg, M., et al. Patients’ and Cardiologists’ Perceptions of the Benefits of Percutaneous Coronary Intervention for Stable Coronary Disease. Annals of Internal Medicine. September 7, 2010 vol. 153 no. 5 307-313