Editorials

Patients are overoptimistic about PCI

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5613 (Published 18 September 2014) Cite this as: BMJ 2014;349:g5613
  1. Jeff Whittle, staff physician1,
  2. Robert Fyfe, US Army2,
  3. Robert D Iles, president3,
  4. Jay Wildfong, US Navy, retired4
  1. 1Primary Care, Clement J Zablocki VA Medical Center, Milwaukee, WI 53295, USA
  2. 2Public Safety Systems Administrator; Waukesha County Government; Waukesha, WI.
  3. 3Mahoosuc Land Trust Board of Directors, Bethel, ME, USA
  4. 4Veterans of Foreign Wars of the United States, Mount Pleasant, WI, USA
  1. Correspondence to: J Whittle Jeffrey.whittle{at}va.gov

They should be equal partners in our efforts to improve understanding

Experts agree that, compared with optimal medical therapy, percutaneous coronary interventions (PCIs) do not improve survival or risk of myocardial infarction in patients with stable coronary artery disease, but they do improve angina. Guidelines therefore recommend PCI for patients with stable coronary artery disease only if there are unacceptable symptoms in the face of adequate medical therapy, or if patients cannot tolerate medical therapy.1

In a linked paper, Kureshi and colleagues report that at 10 US hospitals the vast majority of patients undergoing elective PCI, presumably for stable coronary artery disease, believed that the procedure was being done to extend life or to prevent myocardial infarction.2

Although this finding is not new,3 4 the inclusion of patients treated at multiple hospitals allowed the authors to show that patients were more likely to believe that PCI reduced mortality or the risk of myocardial infarction at some hospitals than at others, though, even where such mistaken beliefs were least likely, 4 out of 5 patients reported these as benefits. Among the nearly 1000 patients surveyed, just 1% correctly reported that the relief of symptoms—not mortality and myocardial infarction risk reduction—was the expected benefit. …

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