scholarly journals The Evolving View of Coronary Artery Calcium: A Personalized Shared Decision-Making Tool in Primary Prevention

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Omar Dzaye ◽  
Cara Reiter-Brennan ◽  
Albert D. Osei ◽  
Olusola A. Orimoloye ◽  
S. M. Iftekhar Uddin ◽  
...  
Keyword(s):  
Decision Making ◽  
Coronary Artery ◽  
Primary Prevention ◽  
Shared Decision Making ◽  
Coronary Artery Calcium ◽  
Risk Groups ◽  
Intermediate Risk ◽  
Shared Decision ◽  
Management Guideline ◽  
Cholesterol Management

The 2018 American Heart Association and American College of Cardiology (AHA/ACC) cholesterol management guideline considers current evidence on coronary artery calcium (CAC) testing while incorporating learnings from previous guidelines. More than any previous guideline update, this set encourages CAC testing to facilitate shared decision making and to individualize treatment plans. An important novelty is further separation of risk groups. Specifically, the current prevention guideline recommends CAC testing for primary atherosclerotic cardiovascular disease (ASCVD) prevention among asymptomatic patients in borderline and intermediate risk groups (5–7.5% and 7.5–20% 10-year ASCVD risk). This additional sub-classification reflects the uncertainty of treatment strategies for patients broadly considered to be “intermediate risk,” as treatment recommendations for high and low risk groups are well established. The 2018 guidelines, for the first time, clearly recognize the significance of a CAC score of zero, where intensive statin therapy is likely not beneficial and not routinely recommended in selected patients. Lifestyle modification should be the focus in patients with CAC = 0. In this article, we review the recent AHA/ACC cholesterol management guideline and contextualize the transition of CAC testing to a guideline-endorsed decision aid for borderline-to-intermediate risk patients who seek more definitive risk assessment as part of a clinician-patient discussion. CAC testing can reduce low-value treatment and focus primary prevention therapy on those most likely to benefit.

scholarly journals Coronary Artery Calcium and Shared Decision Making

2016 ◽  
Vol 9 (5) ◽  
pp. 637-639 ◽  
Author(s):  
Harvey S. Hecht ◽  
Leslee J. Shaw ◽  
Y. Chandrashekhar ◽  
Jagat Narula
Keyword(s):  
Decision Making ◽  
Coronary Artery ◽  
Shared Decision Making ◽  
Coronary Artery Calcium ◽  
Shared Decision

Selective Use of Coronary Artery Calcium Testing for Shared Decision Making: Guideline Endorsed and Ready for Prime Time

2019 ◽  
Vol 170 (4) ◽  
pp. 262 ◽  
Author(s):  
Rhanderson Cardoso ◽  
Khurram Nasir ◽  
Roger S. Blumenthal ◽  
Michael J. Blaha
Keyword(s):  
Decision Making ◽  
Coronary Artery ◽  
Shared Decision Making ◽  
Coronary Artery Calcium ◽  
Prime Time ◽  
Shared Decision

scholarly journals PREPARED Study: A Study of Shared Decision-Making for Coronary Artery Disease

2019 ◽  
Vol 12 (2) ◽  
Author(s):  
Jacob A. Doll ◽  
W. Schuyler Jones ◽  
Yuliya Lokhnygina ◽  
Sara Culpepper ◽  
Robin L. Parks ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Decision Making ◽  
Coronary Artery ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Artery Disease

Abstract 86: What Do Patients Remember? The Knowledge Gap in Patients Undergoing Elective Percutaneous Coronary Interventions

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Grace Lin ◽  
Julie Bynum ◽  
Carol Cosenza ◽  
Adam Lucas ◽  
Celeste Reinking ◽  
...  
Keyword(s):  
Decision Making ◽  
Coronary Artery ◽  
Shared Decision Making ◽  
Bypass Surgery ◽  
Decision Making Process ◽  
Shared Decision ◽  
Percutaneous Coronary ◽  
Decision Making Processes ◽  
Treatment Alternatives ◽  
Physician Patient

Background: There is increasing scrutiny of the use of elective percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD), due to the lack of mortality benefit compared with optimal medical therapy. Because of the clinical equipoise involved, decisions for elective PCI should include the preferences and involvement (to the extent desired) of a well-informed patient. However, there have been no large, national studies directly assessing knowledge and decision-making in patients with stable CAD undergoing elective procedures, so the overall state of knowledge in such patients is not clear. Our objective was to assess whether patients who have undergone elective PCI recalled critical facts and key decision-making processes regarding their treatment. Methods: National cross-sectional survey of 461 randomly sampled Medicare beneficiaries aged ≥ 65 who underwent elective PCI in 2008. Survey questions assessed patient demographics, cardiac history, decision-making processes, and knowledge. Knowledge was measured as the percentage of correct responses to 7 questions about the risks and benefits of elective PCI, bypass surgery and medical therapy for CAD. Questions about the decision-making process included assessment of physician-patient communication about the procedure and the patient's perception of their participation in the decision-making process. Association between knowledge and various predictors was determined using multivariate linear regression. Results: Patients answered a mean of 31.1% of questions correctly, and no patients answered all the questions correctly. Patients having undergone prior coronary artery bypass surgery had slightly more knowledge than those having their first PCI (mean correct score 36.7% vs. 29.4%, p<0.01). In a multivariate model, younger patients and patients who had previous bypass surgery were more knowledgeable. Neither educational level nor the patients’ subjective feeling of being informed was associated with knowledge level. Very few patients reported that their physicians talked about alternate treatment options (4.3%) or asked their preferences about the procedure (14.3%), two critical elements of shared decision-making; however, 67.3% of patients felt that decision-making was equally shared between the physician and patient. Conclusions: Medicare patients who underwent elective PCI had poor recollection about the benefits and risks of PCI, making it difficult to assess whether or not the patients made informed decisions. In addition, patients reported incomplete discussions about treatment alternatives and limited discussion of treatment preferences, despite reporting a high level of perceived shared decision-making. Although it is not clear whether the gaps in knowledge are a result of poor recall by the patient, poor knowledge transfer, or both, greater focus on improving patient knowledge and the physician-patient conversation about treatment alternatives and preferences is needed to ensure that elective PCIs are reflective of the preferences of well-informed patients.

scholarly journals Shared Decision Making in Patients with Stable Coronary Artery Disease: PCI Choice

PLoS ONE ◽  
2012 ◽  
Vol 7 (11) ◽  
pp. e49827 ◽  
Author(s):  
Megan Coylewright ◽  
Kathy Shepel ◽  
Annie LeBlanc ◽  
Laurie Pencille ◽  
Erik Hess ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Decision Making ◽  
Coronary Artery ◽  
Shared Decision Making ◽  
Stable Coronary Artery Disease ◽  
Shared Decision ◽  
Artery Disease

scholarly journals THE IMPACT OF AN INFORMATICS INTERVENTION ON SHARED DECISION-MAKING FOR PRIMARY PREVENTION STATIN THERAPY

2017 ◽  
Vol 69 (11) ◽  
pp. 1834
Author(s):  
Siqin Ye ◽  
Aaron Leppin ◽  
Amy Chan ◽  
Nancy Chang ◽  
Nathalie Moise ◽  
...  
Keyword(s):  
Decision Making ◽  
Primary Prevention ◽  
Statin Therapy ◽  
Shared Decision Making ◽  
Shared Decision ◽  
The Impact
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