Factors Influencing Provider and Patient Choice of P2Y₁₂ Inhibitor Therapy

Area of Science:

• Cardiology
• Pharmacology
• Health Services Research

Background:

• Clopidogrel is a common P2Y12 inhibitor for acute coronary syndrome (ACS) and stent placement.
• Ticagrelor and prasugrel are alternative P2Y12 inhibitors, with selection influenced by medication factors.

Purpose of the Study:

• To identify key factors influencing cardiology provider and patient choices of P2Y12 inhibitors.
• To inform shared decision-making (SDM) processes in P2Y12 inhibitor selection.

Main Methods:

• A single-center study surveyed 32 cardiology providers and 105 patients who received P2Y12 inhibitors for ACS or stent placement.
• Respondents ranked factors influencing P2Y12 inhibitor selection and therapy preferences.
• Patients reported on their experience with the shared decision-making process.

Main Results:

• Cardiology providers prioritized bleeding risk, comfort/experience, and cost; patients prioritized drug interactions, adverse effects, and myocardial infarction reduction.
• Significant differences emerged in the perceived importance of safety factors, daily administration, and cost.
• Prescribing patterns for ticagrelor did not align with provider preferences, and patient involvement in SDM was low (21.6%).

Conclusions:

• Divergent views between providers and patients on P2Y12 inhibitor selection criteria, particularly safety, administration, and cost, necessitate improved communication.
• The majority of patients were not engaged in SDM and were unaware of alternative P2Y12 inhibitor options.