Patients' and Cardiologists' Perceptions of the Benefits of Percutaneous Coronary Intervention for Stable Coronary Disease

Rothberg, Michael B. MD, MPH
Sivalingam, Senthil K. MD
Ashraf, Javed MD, MPH
Visintainer, Paul PhD
Joelson, John MD
Kleppel, Reva MSW, MPH
Vallurupalli, Neelima MD
Schweiger, Marc J. MD

From Baystate Medical Center, Springfield, and Tufts University School of Medicine, Boston, Massachusetts.

For author affiliations, see end of text.

Acknowledgment: The authors thank Raul Octaviani, MD, for help with creating an earlier version of the patient and cardiologist surveys.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0042.

Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Rothberg (e-mail, [email protected]). Data set: Not available.

Requests for Single Reprints: Michael B. Rothberg, MD, MPH, Divisions of General Medicine and Geriatrics, Department of Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199; e-mail, [email protected].

Current author addresses and author contributions are available at www.annals.org.

Current Author Addresses: Dr. Rothberg: Divisions of General Medicine and Geriatrics, Department of Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199.

Dr. Sivalingam and Ms. Kleppel: Division of General Medicine, Department of Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199.

Drs. Ashraf, Joelson, Vallurupalli, and Schweiger: Division of Cardiology, Department of Medicine, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199.

Dr. Visintainer: Department of Statistics and Epidemiology, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199.

Author Contributions: Conception and design: M.B. Rothberg, S.K. Sivalingam, J. Ashraf, J. Joelson, M.J. Schweiger.

Analysis and interpretation of the data: M.B. Rothberg, J. Ashraf, P. Visintainer, M.J. Schweiger.

Drafting of the article: M.B. Rothberg, S.K. Sivalingam, J. Ashraf.

Critical revision of the article for important intellectual content: S.K. Sivalingam, J. Ashraf, P. Visintainer, J. Joelson.

Final approval of the article: M.B. Rothberg, S.K. Sivalingam, J. Ashraf, P. Visintainer, J. Joelson, M.J. Schweiger.

Provision of study materials or patients: J. Joelson.

Statistical expertise: P. Visintainer.

Administrative, technical, or logistic support: J. Ashraf, J. Joelson, R. Kleppel, M.J. Schweiger.

Collection and assembly of data: M.B. Rothberg, S.K. Sivalingam, J. Ashraf, J. Joelson, R. Kleppel, N. Vallurupalli.

Annals of Internal Medicine 153(5):p 307-313, September 7, 2010.

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.