Patient Beliefs Regarding Benefits of Percutaneous Coronary Intervention in Chronic Stable Angina My Summer Research Project of 2014 Carla Lauture, of Elms College Dr. Sarah Goff, of BMC

 H  Angina is pain or discomfort associated with myocardial ischemia – chest, jaw, left arm  Patients may also complain of symptoms that include indigestion, heartburn, weakness, sweating, nausea, cramping, and shortness of breath.

COURAGE - Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation  2,287 participants - at least one narrow artery  Randomized to PCI vs. medical therapy for stable angina  Found that PCI reduces angina symptoms more quickly than medication but does not reduce myocardial infarction or death risk Background

 2010 – stable angina patients believe PCI will prevent MI and death (Rothberg et al.)  2014 – qualitative – cardiologists may not explicitly describe expected benefits of PCI for stable angina (Goff et al.)  2011 – letter to the editor–even if cardiologists spend time explaining PCI, patients may not completely understand – “teach back“ method is essential (Schenker & Meisel) Background

1. To assess stable angina patients’ perceptions of benefits of PCI Hypothesis: The majority of patients will believe PCI reduces risk for MI and death 2. To assess changes in informed consent process for PCI for stable angina at BMC Hypothesis: Cardiologists will report changing informed consent process following 2010 study Specific Aims

 Study design - Survey  125 Stable angina patients awaiting cardiac cath/possible stent  35 Cardiologists who refer or admit to BMC  Methods

 Questionnaire development  Modified original questionnaire  Piloted modifications with patients with stable angina awaiting PCI  Cognitive interviewing  Elicits respondent feedback on: language, comprehensibility, and relevance of questions Methods

 Conducting Survey  Approach stable angina patients awaiting cardiac cath.  Inform of purpose of the study  Read questions to patients (reduce issues with literacy)  Patient exclusions: those who speak a language other than English or Spanish or who are having procedure as pre-op for surgery or valve replacement Methods

 Cardiologists surveyed to assess what if any changes were made in consent process for stable angina patients undergoing cath/possible stent placement  Inclusions: cardiologists who admit or refer to BMC  Exclusions: none Methods

 Patients  Percent of patients who think PCI will reduce risk for MI and/or death  Why patients believe what they do about PCI benefits  Cardiologists  Reported changes in informed consent procedures since 2010 Results

 Patients: English & Spanish speaking patients only  Cardiologists: Social desirability  General: One institution Limitations

 guide/updates/medication-vs-stents-for-heart-disease- treatment  stent-warning_x.htm stent-warning_x.htm  Patients' and cardiologists' perceptions of the benefits of percutaneous coronary intervention for stable coronary disease. Schenker Y, Meisel A. Ann Intern Med Mar 1;154(5):371. doi: /  Optimal Medical Therapy with or without PCI  for Stable Coronary Disease. William E. Boden, M.D., Robert A. O’Rourke, M.D., New England Journal of Medicine. April vol. 356 no. 15 References

 Dr. Sarah Goff, Principal Investigator/Summer Scholar Mentor  Auras Atreyas, Amin Reva Kleppel, Janice Fitzgerald, Sub-investigators of “Patient Beliefs Regarding Benefits of Percutaneous Coronary Intervention in Chronic Stable Angina”  BMC &The Summer Scholars Program Thank you! Acknowledgements