AIM: Older patients hesitant to take meds to prevent CV because of risks

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Older patients are concerned about the potential adverse effects of medication intended to prevent heart attacks, and say they are willing to take these medications only if the benefits outweigh the potential risks, according to a report published online Feb. 28 in the Annals of Internal Medicine.

“Quality-assurance and pay-for-performance initiatives increasingly encourage adherence to evidence-based guidelines for the prevention or management of particular diseases,” the authors wrote. “However, guideline-directed therapy may be at odds with the preferences of the patients who are targeted by the guidelines.”

Because many older patients have multiple risk factors for chronic disease, they may look at the guidelines differently than physicians in terms of weighing the risks and benefits of drug therapy.

Terri R. Fried, MD, of the Yale University School of Medicine in New Haven, Conn., and the VA Connecticut Healthcare System and colleagues evaluated the willingness of older patients to take prescribed medications to heart attack.

The researchers performed 356 in-person interviews with patients who had an average age of 76. Questions revolved around the patients’ willingness to take medication for MI prevention. The researchers described the medication as reducing the patient’s risk of heart attack over the next five years, but noted that the medication could have various types of side effects including dizziness, nausea and slowed thinking.

Eighty-eight percent of patients said they would take the medication if it had no adverse effects—an absolute benefit of six fewer persons with MI out of 100 patients was the average current risk reduction of available medications.

“As the absolute benefit offered by the medication increased, so did the proportion willing to take the medication,” the authors noted.

The authors reported that 48 percent to 69 percent of those interviewed were unwilling to take medications due to their potential to cause mild fatigue or nausea and only 3 percent said that they would take the medication with adverse effects that could affect functioning.

“The central finding of this study was the large influence exerted by the presence of adverse effects on older persons’ decisions about whether to take a medication,” the authors concluded. “These results suggest that clinical guidelines and decisions about prescribing these medications to older persons need to place emphasis on both benefits and harms.”