Document Detail

Doctors' perceptions of the prognostic benefit of statins in patients who have had myocardial infarction.
MedLine Citation:
PMID:  18771433     Owner:  NLM     Status:  In-Process    
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.
N Sapre; S Mann; C R Elley
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-06-28
Journal Detail:
Title:  Internal medicine journal     Volume:  39     ISSN:  1445-5994     ISO Abbreviation:  Intern Med J     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-06-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101092952     Medline TA:  Intern Med J     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  277-82     Citation Subset:  IM    
Department of Medicine, University of Otago, Wellington, New Zealand.
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