Risks and Benefits of Percutaneous Coronary Interventions in Stable Coronary Disease: A Qualitative Analysis of Cardiologists’ Bedside Discussions  

Although the benefits of PCI for stable CAD are limited to symptom reduction, prior studies have shown that patients often believe PCI for stable coronary artery disease (CAD) will mitigate the future risks of myocardial infarction or death. This study examined discussions between cardiologists and patients regarding angiograms and PCI in stable CAD to identify potential areas of misperception. Qualitative content analysis was performed on transcripts created from recordings of 40 patient-provider encounters with cardiologists participating in the Verilogue Point-of-Practice Database. Physician-patient encounters were coded for five major categories and subcategories that may explain patients’ perceptions of PCI benefit including the rationale for recommending the procedure, a discussion of benefits, a discussion of risks, provider communication style, and patients and family members contributions to the discussion. Cardiologist employed a range of accurate and empathic approaches to discussing consideration of PCI (e.g., “people have this misconception if they get a stent, they’re going to live longer. That’s not true. The main thing stents do is they prevent symptoms.”). However, this qualitative study also found evidence of implicit and explicit inaccuracies (e.g., claiming PCI “fixes the problem” or reduces risk of future heart attack) as cardiologists discussed consideration of PCI with stable CAD patients.

Conclusions: Physician discussions may contribute to patient misperceptions in the therapeutic benefit of coronary procedures. Further study of standardized patient decision support tools is warranted to assist patients and providers to achieve evidence based and patient-centric treatment decisions.

 

Summarized by Jehu S. Mathew and Steven M. Bradley

 

Goff SL, Mazor KM, Ting HH, Kleppel R, Rothberg MB. How cardiologists present the benefits of percutaneous coronary interventions to patients with stable angina: a qualitative analysis. JAMA Intern Med. 2014; 174:1614-21.