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. 1997 Sep;6(3):131–139. doi: 10.1136/qshc.6.3.131

Risks and benefits of coronary angioplasty: the patients perspective: a preliminary study.

F Kee 1, P McDonald 1, B Gaffney 1
PMCID: PMC1055474  PMID: 10173770

Abstract

OBJECTIVES: To describe what cardiac patients in Northern Ireland understand to be the benefits of coronary angioplasty and assess the extent to which they have been able to make informed choices about their treatment. DESIGN: An interview based questionnaire survey completed after the patients had undergone coronary angiography, within hours of treatment counselling. SUBJECTS: 150 patients consecutively recruited from two regional cardiology centres in Belfast, Northern Ireland. MAIN OUTCOME MEASURES: The perceived complication rate and the perceived gain in life expectancy from coronary angioplasty. RESULTS: Although most subjects had asked the consultant questions, 70% (n = 104) thought that they contributed negligibly or not at all to the treatment decision. Although 75% (n = 112) recalled discussing the complication rate from the procedure, only 27% accurately estimated this rate (as between 0.5 and 1.5%). Eighty eight per cent (n = 131) thought that their mortality risks would be substantially or greatly reduced by having the procedure. The patients anticipated a gain in life expectancy of some 10 years (median) and this was significantly in excess of the potential gain in life expectancy which dietary prudence to lower blood cholesterol, not smoking, and taking more exercise might produce (median 5 years respectively; P < 0.0001, Wilcoxon matched pairs signed rank test). CONCLUSIONS: Patients vastly overrate the capacity of angioplasty to control their disease: angioplasty is seen as more effective than risk factor modification.

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Selected References

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  1. Cox J., Naylor C. D. The Canadian Cardiovascular Society grading scale for angina pectoris: is it time for refinements? Ann Intern Med. 1992 Oct 15;117(8):677–683. doi: 10.7326/0003-4819-117-8-677. [DOI] [PubMed] [Google Scholar]
  2. Eraker S. A., Becker M. H., Strecher V. J., Kirscht J. P. Smoking behavior, cessation techniques, and the health decision model. Am J Med. 1985 May;78(5):817–825. doi: 10.1016/0002-9343(85)90289-x. [DOI] [PubMed] [Google Scholar]
  3. Gaw B. L. Motivation to change life-style following PTCA. Dimens Crit Care Nurs. 1992 Mar-Apr;11(2):68–74. doi: 10.1097/00003465-199203000-00005. [DOI] [PubMed] [Google Scholar]
  4. Goldberg R. K., Kleiman N. S., Minor S. T., Abukhalil J., Raizner A. E. Comparison of quantitative coronary angiography to visual estimates of lesion severity pre and post PTCA. Am Heart J. 1990 Jan;119(1):178–184. doi: 10.1016/s0002-8703(05)80098-5. [DOI] [PubMed] [Google Scholar]
  5. Grover S. A., Lowensteyn I., Esrey K. L., Steinert Y., Joseph L., Abrahamowicz M. Do doctors accurately assess coronary risk in their patients? Preliminary results of the coronary health assessment study. BMJ. 1995 Apr 15;310(6985):975–978. doi: 10.1136/bmj.310.6985.975. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Holmes-Rovner M. Evaluation standards for patient decision supports. Med Decis Making. 1995 Jan-Mar;15(1):2–3. doi: 10.1177/0272989X9501500102. [DOI] [PubMed] [Google Scholar]
  7. Horton R. The context of consent. Lancet. 1994 Jul 23;344(8917):211–212. doi: 10.1016/s0140-6736(94)92992-0. [DOI] [PubMed] [Google Scholar]
  8. Horton R. The context of consent. Lancet. 1994 Jul 23;344(8917):211–212. doi: 10.1016/s0140-6736(94)92992-0. [DOI] [PubMed] [Google Scholar]
  9. Hux J. E., Naylor C. D. Communicating the benefits of chronic preventive therapy: does the format of efficacy data determine patients' acceptance of treatment? Med Decis Making. 1995 Apr-Jun;15(2):152–157. doi: 10.1177/0272989X9501500208. [DOI] [PubMed] [Google Scholar]
  10. Kee F., Gaffney B., Canavan C., Little J., McConnell W., Telford A. M., Watson J. D. Expanding access to coronary artery bypass surgery: who stands to gain? Br Heart J. 1995 Feb;73(2):129–133. doi: 10.1136/hrt.73.2.129. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kee F. Patients' prerogatives and perceptions of benefit. BMJ. 1996 Apr 13;312(7036):958–960. doi: 10.1136/bmj.312.7036.958. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Kimball B. P., Bui S., Cohen E. A., Cheung P. K., Lima V. Systematic bias in the reporting of angioplasty outcomes: accuracy of visual estimates of absolute lumen diameters. Can J Cardiol. 1994 Oct;10(8):815–820. [PubMed] [Google Scholar]
  13. Lamb G. C., Green S. S., Heron J. Can physicians warn patients of potential side effects without fear of causing those side effects? Arch Intern Med. 1994 Dec 12;154(23):2753–2756. doi: 10.1001/archinte.1994.00420230150018. [DOI] [PubMed] [Google Scholar]
  14. Langford E., de Belder A. Consent procedure for coronary angioplasty is haphazard. BMJ. 1997 Jun 14;314(7096):1762–1762. doi: 10.1136/bmj.314.7096.1762. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. McNeil B. J., Pauker S. G., Sox H. C., Jr, Tversky A. On the elicitation of preferences for alternative therapies. N Engl J Med. 1982 May 27;306(21):1259–1262. doi: 10.1056/NEJM198205273062103. [DOI] [PubMed] [Google Scholar]
  16. McNeil B. J., Pauker S. G., Sox H. C., Jr, Tversky A. On the elicitation of preferences for alternative therapies. N Engl J Med. 1982 May 27;306(21):1259–1262. doi: 10.1056/NEJM198205273062103. [DOI] [PubMed] [Google Scholar]
  17. Mullen P. D., Mains D. A., Velez R. A meta-analysis of controlled trials of cardiac patient education. Patient Educ Couns. 1992 Apr;19(2):143–162. doi: 10.1016/0738-3991(92)90194-n. [DOI] [PubMed] [Google Scholar]
  18. Naylor C. D., Llewellyn-Thomas H. A. Can there be a more patient-centred approach to determining clinically important effect sizes for randomized treatment trials? J Clin Epidemiol. 1994 Jul;47(7):787–795. doi: 10.1016/0895-4356(94)90176-7. [DOI] [PubMed] [Google Scholar]
  19. Oldridge N. B., Streiner D. L. The health belief model: predicting compliance and dropout in cardiac rehabilitation. Med Sci Sports Exerc. 1990 Oct;22(5):678–683. doi: 10.1249/00005768-199010000-00020. [DOI] [PubMed] [Google Scholar]
  20. Paffenbarger R. S., Jr, Hyde R. T., Wing A. L., Lee I. M., Jung D. L., Kampert J. B. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med. 1993 Feb 25;328(8):538–545. doi: 10.1056/NEJM199302253280804. [DOI] [PubMed] [Google Scholar]
  21. Rollnick S., Kinnersley P., Stott N. Methods of helping patients with behaviour change. BMJ. 1993 Jul 17;307(6897):188–190. doi: 10.1136/bmj.307.6897.188. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Rothert M., Rovner D., Holmes M., Schmitt N., Talarczyk G., Kroll J., Gogate J. Women's use of information regarding hormone replacement therapy. Res Nurs Health. 1990 Dec;13(6):355–366. doi: 10.1002/nur.4770130603. [DOI] [PubMed] [Google Scholar]
  23. Stewart M. A. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995 May 1;152(9):1423–1433. [PMC free article] [PubMed] [Google Scholar]
  24. Tsevat J., Weinstein M. C., Williams L. W., Tosteson A. N., Goldman L. Expected gains in life expectancy from various coronary heart disease risk factor modifications. Circulation. 1991 Apr;83(4):1194–1201. doi: 10.1161/01.cir.83.4.1194. [DOI] [PubMed] [Google Scholar]
  25. Underwood M. J., Firmin R. K., Jehu D. Aspects of psychological and social morbidity in patients awaiting coronary artery bypass grafting. Br Heart J. 1993 May;69(5):382–384. doi: 10.1136/hrt.69.5.382. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Wager E., Tooley P. J., Emanuel M. B., Wood S. F. How to do it. Get patients' consent to enter clinical trials. BMJ. 1995 Sep 16;311(7007):734–737. doi: 10.1136/bmj.311.7007.734. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Wills C. E., Moore C. F. Judgment processes for medication acceptance: self-reports and configural information use. Med Decis Making. 1994 Apr-Jun;14(2):137–145. doi: 10.1177/0272989X9401400206. [DOI] [PubMed] [Google Scholar]

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