Effectiveness of patient decision aids for cardiovascular decisions: systematic review with sex/gender-based analysis

Determine effectiveness of cardiovascular patient decision aids (PtDAs), assess consideration for sex and/or gender in included trials, and report whether PtDAs included sex/gender information in personal cardiovascular risk calculations, benefits or harms.

Systematic review with meta-analysis. Independent reviewers screened 209 trials in the 2024 Cochrane Review of PtDAs for eligible cardiovascular trials with updated search to February 2025. Primary outcomes: attributes of the decision-quality and decision-making process. We conducted meta-analysis for similarly measured outcomes. We assessed sex/gender considerations according to International Committee of Medical Journal Editors' recommendations. Thirty-two trials evaluated PtDAs vs. usual care on cardiovascular screening (n = 3 trials; 9.4%), prevention (n = 4; 12.5%), and treatment (n = 25; 78.1%) decisions. There was no difference between groups on decision quality (2 trials). Patients exposed to PtDAs had significantly improved decision-making process outcomes: 12% greater knowledge (20 trials), 127% more accurate risk perceptions (7 trials), 10% feel less uninformed (12 trials), 8% less unclear values (12 trials), and 31% less clinician-controlled decision-making (4 trials). There were no harms. All 32 trials reported sex or gender with 15 (47%) using appropriate terms. One trial reported outcomes separately by sex, but not by study arm. Six (19%) discussed influence of sex/gender on trial findings. Fourteen (43.8%) PtDAs included sex/gender personalized cardiovascular risk scores.

Cardiovascular PtDAs improve quality of the decision-making process. Less than half of trials used appropriate sex/gender terms and only one reported findings separately by sex/gender. Future PtDA research must improve sex and gender-based reporting and analysis.