Обзор американских кардиологических журналов за неделю (ссылки)

[Chevychelov]

Discrepancies found between physician and patient expectations of PCI

Fernandez A. Ann Intern Med. 2010;153:342-343.

Rothberg M. Ann Intern Med. 2010;153:307-313.

Substantial differences exist between patients’ and physicians’ perceptions of percutaneous coronary intervention, including most patients who expect the procedure to lower their risk for MI, results from a new study suggest.

The study included 153 patients who consented to elective coronary catheterization, 10 interventional cardiologists and 17 referring cardiologists. Of the patients, 68% had angina, 42% activity-limiting angina, 77% had a positive stress test and 29% had previous MI. Researchers measured patients’ and cardiologists’ perception about the benefits of PCI.

They reporte that nearly three-quarters of patients said they believed that without PCI, they would likely have MI within 5 years. Further, 88% of patients expected PCI to lower MI risk, with patients significantly more likely than physicians to believe that PCI would prevent MI (prevalence ratio, 4.25; 95% CI, 2.31-7.79) or fatal MI (prevalence ratio, 4.83; 95% CI, 2.23-10.46).

Among the study limitations were the small population size, single-center design and limited availability of information concerning pre-catheterization counseling.

“Most patients undergoing the procedure still believe that PCI will prevent infarction or death,” the researchers concluded. “Further efforts should be directed toward improving communication of medical evidence to help patients make informed decisions about this common procedure.”

In an accompanying editorial, Alicia Fernandez, MD, associate professor of clinical medicine with the University of San Francisco, said most clinicians will not find these results surprising because patients commonly overestimate or misunderstand the benefits of treatment.

“That the processes we typically use fail to accurately convey information on expected benefits is particularly distressing for stable CAD, a model condition for ‘preference-sensitive decision-making,’” she said, adding that informed consent requires physicians to do more than tell their patients about the risks of the offered treatments. “We need to make sure our patients also fully understand the anticipated benefits.”
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Education less preventive of CVD in low- to mid-income countries vs. high-income countries
Goyal A. Circulation. 2010;doi:10.1161/circulationaha.109.919274.
Participants’ educational level was not preventive of CVD in low- and middle-income countries. However, in high-income countries, researchers reported an inverse association with several key CV risk factors.

“Atherothrombotic diseases — coronary heart disease, cerebrovascular disease and peripheral arterial disease — are the leading cause of death worldwide,” the REACH investigators wrote in their study. “Attained educational level is a socioeconomic indicator that strongly predicts CV outcomes.”

The Reduction of Atherothrombosis for Continued Health (REACH) Registry was a prospective study of participants (n=67,888) with either established atherothrombotic disease or multiple atherothrombotic risk factors enrolled from physician practices (n=5,587) located in 44 countries. Attained educational level was self-reported at baseline in 61,332 participants. Researchers stratified outcomes, including baseline prevalence of atherothrombotic risk factors and the rate of incident CV events, by sex and world region through 23 months across AEL groups.

According to study data, attained educational level was directly associated with hypercholesterolemia but inversely related to age and diabetes mellitus in all participants. Researchers also reported that attained educational level was inversely associated with risk factors such as obesity, hypertension, smoking and baseline burden of vascular disease in high-income countries, but not in low- and middle-income countries. The protective effect of greater attained educational levelon incident CV events from high-income countries was most pronounced in men (P<.0001) than in women (P=.0026), whereas the association was not statistically significant in men or women from low- and middle-income countries.

“These results indicate that studies that report a protective association between attained educational level and CV outcomes in [high-income countries] do not extrapolate to [low- and middle-income countries], especially in women,” the researchers concluded. “Further studies dedicated to [low- and middle-income countries] settings are essential to investigate the association between socioeconomic indicators and CV outcomes in these regions.”