Patients' preferences for coronary revascularization: a systematic review

Area of Science:

• Cardiovascular Medicine
• Health Services Research
• Patient-Reported Outcomes

Background:

• Coronary revascularization recommendations often rely on composite outcomes not aligned with patient values.
• Existing guidelines may inadequately represent individual patient preferences for treatment selection.

Purpose of the Study:

• To systematically review and synthesize existing literature on stated preference (SP) methods in coronary revascularization.
• To evaluate how patient preferences are currently considered in treatment decisions for coronary artery disease.

Main Methods:

• Systematic literature search of Medline, Embase, and Lilacs databases.
• Independent screening of 735 citations by two reviewers, with consensus for inclusion.
• Qualitative synthesis of six included studies on stated preference regarding coronary revascularization.

Main Results:

• Commonly studied attributes in SP research include death, myocardial infarction, stroke, and repeat revascularization.
• Half of the studies analyzed composite endpoints, revealing discrepancies in attribute weighting and patient-physician agreement.
• Diverse methods were employed, including rating, ranking, standard gamble, willingness to pay, and discrete choice experiments.

Conclusions:

• There is a limited focus on patient preferences in coronary revascularization research despite numerous efficacy studies.
• Future trials must explore patient preferences in outcome selection and weighting for treatment trade-offs.
• Incorporating patient-centered outcomes is crucial for improving the relevance of revascularization recommendations.