Rating the Preferences for Potential Harms of Treatments for Cardiovascular Disease

Background. The Institute of Medicine has called for a new health care paradigm that integrates patient values into discussions of the risks and benefits of treatment. Although cardiovascular disease (CVD) affects one-third of Americans, little is known about how adults regard the potential harms or complications of treatment. Objective. We sought to determine the preferences of community-dwelling adults for 15 potential harms or complications resulting from treatment of CVD. Methods. In a telephone survey, adults older than 18 years residing on Long Island, New York, were asked to score the preferences for 15 potential harms or complications of treatment of CVD on a scale from 0 to 100. All statistical analyses were based on nonparametric methods. Multivariable general linear model analyses were performed to identify demographic factors associated with the score assigned for each adverse outcome. Results. The 807 individuals surveyed generated 723 unique sequences of scores for the 15 outcomes. The ranking of scores from least to most acceptable was stroke, major myocardial infarction (MI), cognitive dysfunction, renal failure, death, prolonged ventilator support, heart failure, angina, sternal wound infection, major bleeding, reoperation, prolonged recovery in a nursing home, cardiac readmission, minor MI, and percutaneous coronary intervention. Demographic factors accounted for less than 7% of the observed variation in the score attributed to each outcome. Conclusions. Individual community-dwelling adults living on Long Island, New York, assign unique values to their preferences for potential harms encountered following treatment of CVD. Thus, risk-benefit discussions and treatment decisions regarding CVD should be harmonized to the value system of each individual.