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Does the type of treatment affect who makes the decision? Secondary data analysis of patients undergoing angioplasty vs. medical treatment for high cholesterol levels

Ana Tereza Azeredo Bastos Brito and Gustavo Carvalho

Objectives: The objective of our study is to compare decision-making preferences regarding who makes the final treatment decision comparing two conditions: (1) Use of medication for high cholesterol and (2) angioplasty or/and bypass for coronary artery disease. Methods: We used data from the National Survey of Medical Decisions (the DECISIONS study). All subjects completing the DECISIONS survey modules on high cholesterol medication and cardiac procedures (angioplasty or/and bypass) for coronary artery disease were included in our analysis. Our primary outcome of interest was the person who made the final decision (provider or patient). Our analyses were adjusted for the corresponding set of weights (multipliers relating the sample to the total population) and strata (subpopulations). These adjustments allow for the inference of results to a population rather than being limited to our study sample. Results: The estimated target population comprised of 144,807,605 individuals, with a mean age of 62.2 years ± 0.53, 45.3% being female, and most were white (73.4%). Only 24.4% of all patients reported that the decision was mainly theirs. When comparing the primary outcomes between patients in both groups, a majority of individuals in the high cholesterol medication group expressed that the therapeutic decision was mainly theirs unlike those in the cardiac procedures group (24.4%±2.1% vs. 16.1%±5%). This finding was more pronounced among women (21.7%±2.8% vs. 6%±3.5%). Conclusion: The nature of a medical intervention modifies the decision patterns and preferences of patients in the field of cardiology. Shared decision-making was not predominant among cardiac conditions.