Purpose: Prevention guidelines indicate that large numbers of middle aged and older people should use statins. In practice, many fewer are prescribed such drugs, and considerable proportions discontinue their treatment. The purpose of this study was to identify factors that may influence people’s decisions regarding a cardiovascular prevention drug.
Method: A representative sample of 4,000 individuals aged 40-69 in Odense, Denmark, was randomly selected and invited for an interview. 1,491 (37%) were successfully interviewed, and 1,169 interviews were used in this study. Subjects were randomised into 16 different groups, comprising different baseline risk levels (5% or 15% 10-year risk of fatal heart attack) and effectiveness groups (2%, 4%, 5%, 10% in terms of absolute risk reduction). Interviewees were asked to imagine themselves at increased risk of cardiovascular disease and for that reason offered treatment with a hypothetical drug. They received comprehensive information about the effectiveness in terms of absolute risk reduction, relative risk reduction, number needed to treat, and life extension. Subsequently, they were asked whether they would or would not consent to therapy. Finally, they were asked about the reasons for consenting or not consenting.
Result: For absolute risk reductions of 2%, 4%, 5% and 10%, the proportion of subjects accepting treatment were 57%, 69%, 68% and 73%, respectively. Among those who consented to therapy, 45% said it was because of their health, 32% because of family considerations, and 17% because of confidence in the doctor. Among those who rejected therapy, preference for life-style changes (56%), fear of side-effects (19%), and low effectiveness (13%) were the most frequently stated reasons. Reasons were independent of socio-demographic characteristics and presentation of effectiveness information.
Conclusion: The level of health benefit seems to have a moderate influence on people’s decisions about preventive drugs while important personal and inter-personal aspects, e.g. family situation, availability of non-medical alternatives, and trust in the doctor were reported as influencing decisions. The findings suggest that physicians may do well in discussing these reasons for treatment decisions with their patients in order to make optimal decisions.
Candidate for the Lee B. Lusted Student Prize Competition