Objectives: It is well documented that antithrombotic therapies prevent thrombotic events (benefits) in many clinical settings, but also are associated with an increased risk of bleeding (risks). However, it is not entirely clear how the tradeoff between these health outcomes is perceived by patients and physicians, particularly when treating acute coronary syndrome (ACS). The current study aims to quantify US patient and physician preferences for health outcomes associated with antithrombotic therapies in ACS.
Methods: Patients ≥18 years old who were hospitalized within the last 5 years due to a heart attack and have used aspirin or prescription blood thinners, and board-certified cardiologists participated in a web-based, best-worst scaling survey. Each best-worst scaling question included 3 possible outcomes and participants were asked to select the best and worst outcomes in each question. Outcomes included death, and various levels of stroke, myocardial infarction, and bleeding. Data were analyzed using a maximum difference model employing random-parameters logit.
Results: Responses from 206 patients and 273 physicians met face validity requirements and were analyzed. For both physicians and patients, non-fatal major disabling stroke was nearly equivalent to death in terms of relative importance, and non-fatal moderate bleeding was the least important. For physicians, severe myocardial infarction was equivalent to 0.92 (standard error, ±0.02) deaths, while non-fatal moderate stroke was equivalent to 0.64 (±0.05) deaths. For patients, non-fatal moderate stroke was equivalent to 0.35 (±0.04) deaths, while non-fatal major bleeding requiring transfusion was equivalent to 0.13 (±0.02) deaths, and non-fatal heart attack was equivalent to 0.09 (±0.02) deaths. All remaining ACS outcomes were equivalent to fewer than 0.03 deaths.
Conclusions: US patients and physicians viewed death and disabling stroke as the most important and non-fatal moderate bleeding as the least important outcomes for antithrombotic therapy. These results might be informative for making treatment decisions.
