Cardiologist Criteria For Recommending Patient Decision Aids

Patient decision aids are tools designed to help people participate in decision making about health care treatment options. They provide information in DVD, web or print format on different treatment options and outcomes as a way to help patients make informed decisions, based on their personal goals and preferences, with their practitioner.

The January CardioSurve explored the concept of shared decision making and patient decision aids with a focus on two patient treatment scenarios — atrial fibrillation and high cholesterol.

Overall, the majority of cardiologists support shared, collaborative decision making with patients. For example, when an atrial fibrillation patient with a CHADS2 score of zero is contemplating an aspirin regimen to lower stroke risk, then approximately half of cardiologists (49%) believe that this treatment decision is more evenly shared by the cardiologist and patient. However, in the case of an atrial fibrillation patient with a CHADS2 score of two or higher and the treatment consideration involves warfarin or a new oral anticoagulant to lower stroke risk, then nearly three out of four cardiologists (73%) say that the decision lies with the cardiologist; significantly fewer (25%) feel that the patient shares equally in owning the treatment decision in this particular scenario. Although cardiologists are much more likely to dictate the course of treatment as the gravity of the patient condition increases, they still recognize that patient input and co-ownership of the care decision are vital.

The same pattern emerges with high cholesterol. Sixty percent of cardiologists indicate that the physician should be the primary decision maker on whether a patient with high cholesterol should take a statin; two-in-five cardiologists believe that patients share equally in the treatment decision.

What Cardiologists Want Patients to Know Before Making a Treatment Decision

For the most part cardiologists are not regularly utilizing DVDs, specific websites, or print materials with information about treatment options to their patients with atrial fibrillation or high cholesterol. Less than one-third regularly offer decision information on atrial fibrillation (30%) or high cholesterol (25%) to their patients. However, almost all cardiologists (91%) indicate they would regularly recommend a decision aid that met their standards.

So, what are the qualities of an effective patient decision making tool for patients with atrial fibrillation or high cholesterol?

For atrial fibrillation patients making a decision about taking an anti-clotting medication, the most important information cardiologists would like for their patients to know is the rate at which strokes occur in patients with similar risk factors who do not take anti-clotting medication (88%), whether they have any other health conditions that might affect their risk of stroke (87%), information about what “atrial fibrillation” is (85%), information about the steps they will need to take to monitor the effects of their anti- clotting medication (84%), the increase in the rate of major bleeding among patients taking anti-clotting medication (80%), and the rate at which strokes occur in patients with similar risk factors who take anti-clotting medication (80%).

For patients with high cholesterol considering a statin for primary prevention of cardiovascular events, cardiologists would primarily like for these patients to know whether they have any other health conditions that might affect their risk of cardiovascular events (79%), the rate at which cardiovascular events occur in patients with similar risk factors who do not take statins (71%), and the rate at which cardiovascular events occur in patients with similar risk factors who take statins (69%).

Not surprisingly, nearly all cardiologists (97%) believe that it is important for them to first view the patient decision aid material themselves before patient recommendation. Also important is ACC approval on patient decision aids (91%).

More than four out of five (84%) believe that patient decision aids should be created by an organization that has no ties to the pharmaceutical industry. While three-quarters (75%) value the approval of other national medical associations, significantly fewer (39%) find government agency approval important.

The ACC in conjunction with other healthcare organizations is pursuing initiatives that seek to develop through its CardioSmart.org patient portal shared-decision making tools for clinicians and patients that seek to transform the way health care is delivered. With the development of these tools, the College will continue to support patient decision making.