Table 7.
Checklist for Clinician-Patient Shared Decision-Making for Initiating Therapy
| Checklist Item | Recommendation |
|---|---|
| ASCVD risk assessment | Assign to statin treatment group; use ASCVD Risk Estimator Plus.* |
| In lower-risk primary-prevention adults 40–75 y of age with LDL-C ≥70 mg/dL (≥1.8 mmol/L). | |
| Not needed in secondary prevention, in those with LDL-C ≥190 mg/dL (≥4.9 mmol/L), or in those 40–75 y of age with diabetes mellitus. | |
| Assess other patient characteristics that influence risk. See Risk-Enhancing Factors (Section 4.4.1.3. and Table 6). | |
| Assess CAC (Section 4.4.1.4.) if risk decision is uncertain and additional information is needed to clarify ASCVD risk. | |
| Use decision tools to explain risk (eg, ASCVD Risk Estimator Plus,* Mayo Clinic Statin Choice Decision Aidt). | |
| Lifestyle modifications | Review lifestyle habits (eg, diet, physical activity, weight or body mass index, and tobacco use). |
| Endorse a healthy lifestyle and provide relevant advice, materials, or referrals, (eg, CardioSmart‡, AHA Life’s Simple 7§, NLA Patient Tear Sheets||, PCNA Heart Healthy Toolbox¶, cardiac rehabilitation, dietitian, smoking cessation program). | |
| Potential net clinical benefit of pharmacotherapy | Recommend statins as first-line therapy. |
| Consider the combination of statin and nonstatin therapy in selected patients. | |
| Discuss potential risk reduction from lipid-lowering therapy. | |
| Discuss the potential for adverse effects or drug- drug interactions. | |
| Cost considerations | Discuss potential out-of-pocket cost of therapy to the patient (eg, insurance plan coverage, tier level, copayment). |
| Shared decision-making | Encourage the patient to verbalize what was heard (eg, patienťs personal ASCVD risk, available options, and risks/benefits). |
| Invite the patient to ask questions, express values and preferences, and state ability to adhere to lifestyle changes and medications. | |
| Refer patients to trustworthy materials to aid in their understanding of issues regarding risk decisions. | |
| Collaborate with the patient to determine therapy and follow-up plan. | |
ASCVD Risk Predictor Plus is available at: http://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/ http://static.heart.org/riskcalc/app/index.html#!/baseline-risk. Accessed September 1, 2018.
Mayo Clinic Statin Decision Aid information is available at: https://statindecisionaid.mayoclinic.org.
CardioSmart health information is available at: https://www.cardiosmart.org/About.
AHA Life’s Simple 7 information is available at: https://www.heart.org/en/healthy-living/healthy-lifestyle/my-life-check-lifes-simple-7.
NLA Patient Tear Sheets information is available at: https://www.lipid.org/practicetools/tools/tearsheets.
PCNA Heart Healthy Toolbox information is available at: http://pcna.net/clinical-tools/tools-for-healthcare-providers/heart-healthy-toolbox.
AHA indicates American Heart Association; ASCVD, atheroscleroticcardiovascular disease; CAC, coronary artery calcium; CKD, chronic kidneydisease; HIV, human immunodeficiency virus; LDL-C, low-density lipoproteincholesterol; PCNA, Preventive Cardiology Nurses Association and NLA,National Lipid Association.