Patient preferences for cardiovascular preventive medication: a systematic review

Area of Science:

• Cardiovascular Medicine
• Health Psychology
• Clinical Pharmacology

Background:

• Patient adherence to preventive medication is crucial for cardiovascular disease (CVD) management.
• Understanding patient perception of risk reduction is key to improving medication uptake.
• Previous research has explored patient willingness to take medications based on various benefit metrics.

Purpose of the Study:

• To systematically review the minimum acceptable risk reduction for cardiovascular events that justifies daily preventive medication intake.
• To analyze how different risk communication frames (e.g., life prolongation, absolute risk reduction, number needed to treat) influence patient decision-making.

Main Methods:

• A systematic review of cited articles using Web of Science, focusing on studies published until November 2016.
• Inclusion criteria required quantitative assessment of minimum acceptable benefit and patient choice regarding medication uptake.
• Analysis of 22 eligible studies involving 17,751 participants.

Main Results:

• Framing using prolongation of life (POL): 48% accepted <8 months, 64% accepted ≥8 months.
• Framing using absolute risk reduction (ARR): 54% accepted <3% 5-year CVD risk reduction, 77% accepted ≥3%.
• Framing using number needed to treat (NNT): 60% accepted NNT >30, 71% accepted NNT ≤30.

Conclusions:

• A substantial risk reduction is generally required for patients to consider daily preventive medication worthwhile.
• Patient acceptance increases with higher perceived benefits, regardless of framing.
• Even cost-free, side-effect-free medications require significant demonstrated benefit for patient adherence.