Elsevier

American Heart Journal

Volume 154, Issue 4, October 2007, Pages 662-668
American Heart Journal

Clinical Investigations
Interventional Cardiology
Understanding of the benefits of coronary revascularization procedures among patients who are offered such procedures

https://doi.org/10.1016/j.ahj.2007.04.065Get rights and content

Background

To participate meaningfully in decisions regarding invasive procedure use, patients should understand the benefits and risks. Previous work has focused on risks; we assessed patient understanding of the benefits of coronary revascularization procedures.

Methods

We interviewed 1650 patients and their treating physicians after elective coronary angiography performed at 3 Veterans Health Administration hospitals and 1 university hospital. We excluded patients for whom the decision to undergo revascularization was made before admission. This report focuses on 633 patients who had been offered coronary artery bypass surgery (CABG, n = 324) or percutaneous coronary interventions (PCIs) and responded to questions about expected benefits. Both patient and physician were asked to report the benefits they expected from revascularization. Forty-nine physicians reported on 490 patients.

Results

Most patients were older (mean age 63.8 years), white (89.4%), and male (77.6%). Most patients expected improved symptoms (83%) and survival (83%). Physician-patient agreement regarding whether survival would improve was no better than chance (κ = 0.02 for CABG, κ = −0.01 for PCI, both P > .10). There was also poor agreement regarding whether symptoms were expected to improve, but this was better than chance (κ = 0.09, P = .01 for CABG; κ = 0.19, P = .02 for PCI). Physician-patient agreement was poor regardless of patient characteristics.

Conclusions

Patients have more optimistic expectations about benefits of coronary revascularization than the cardiologist offering the procedure. Further research should confirm this finding and clarify how physician-patient disagreement regarding the benefits of coronary revascularization affects patient participation in decision making.

Section snippets

Study population

Trained research assistants (RAs) approached individuals scheduled for elective coronary angiography (CATH) at 3 Veterans Health Administration (VHA) hospitals and 1 university hospital from November 1997 through June 1999. All 4 sites had the capacity to perform PCI or CABG. Each VHA site performed 600 to 800 CATHs annually; the university hospital, 5000. All sites were tertiary care hospitals whose medical school affiliation included on-site cardiology fellowships. Two VHA hospitals were

Results

We enrolled 1650 patients. Of these, 633 (38.4%) reported that they had been offered coronary revascularization and answered questionnaire items regarding the expected benefits of the procedure. Most patients were older (mean age 63.8 years), white (89.4%), and male (77.6%), consistent with the population at study hospitals. The population was nearly evenly divided between VHA and university patients. Approximately half (n = 324) were offered CABG. Characteristics of patients offered CABG and

Discussion

In a large population of patients faced with a coronary revascularization decision, we found that many of those patients expected benefits that their physicians did not expect. Both the patients' reports of what the physician told them were the benefits and their beliefs about the procedure's benefits were essentially unrelated to the benefits expected by their physicians. The results suggest that physicians and patients are not communicating successfully about this key decision element.

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