Doctors' perceptions of the prognostic benefit of statins in patients who have had myocardial infarction

• Published in: Internal medicine journal 2009-05, Vol.39 (5), p.277-282
• Main Authors: Sapre, N., Mann, S., Elley, C. R.
• Format: Article
• Language: English
• Subjects: Attitude of Health Personnel; communication; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; hydroxymethylglutaryl-coenzyme A reductase inhibitor; Myocardial Infarction - diagnosis; Myocardial Infarction - drug therapy; patient acceptance of health care; Physician's Role - psychology; Physician-Patient Relations; Prognosis; risk assessment; Risk Factors; secondary prevention; Surveys and Questionnaires
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1111/j.1445-5994.2008.01729.x

Background: We wished to assess how General Practitioners (GPs) and cardiologists perceive and communicate the benefits of therapy with statins (hydroxymethylglutaryl‐coenzyme A reductase inhibitors) in a patient following myocardial infarction. Methods: We interviewed 20 GPs and 22 cardiologists to determine treatment policy and ways of expressing its benefits to a patient after myocardial infarction with moderate dyslipidaemia. We asked what drug and dosage they would recommend and how they would express potential benefits of therapy, given a range of options including reduced relative and absolute risk of events. Results: Most GPs would start a low dose (10–20 mg/day) of simvastatin (the only freely prescribable funded statin in New Zealand) whereas cardiologists would commence 40 mg/day immediately (P = 0.001). All but one cardiologist would justify therapy to the patient by citing a reduced chance of a major adverse cardiovascular event. Nine GPs and one cardiologist estimated a gain of more than 5 years of life from statin therapy. Cardiologists were more optimistic than GPs about relative risk reduction (P = 0.04). Only 50% of GPs and 68% of cardiologists were able to estimate an absolute risk reduction over 5 years, such estimates varying widely with no significant difference in responses between the groups (P = 0.2). No doctors felt comfortable using number needed to treat or odds ratio. Conclusion: There were substantial differences between the two groups of clinicians in perception and policy of statin therapy, frequent overestimation of treatment benefits and a reluctance to impart numerical estimates of benefit to patients.