Clinician-Patient Risk Discussion for Atherosclerotic Cardiovascular Disease Prevention

• Type of Material: Article
• Authors: Seth S. Martin, Johns Hopkins University School of Medicine; Laurence Sperling, Emory University; Michael J. Blaha, Johns Hopkins University School of Medicine; Peter Wilson, Emory University; Ty J. Gluckman, Johns Hopkins University School of Medicine; Roger S. Blumenthal, Johns Hopkins University School of Medicine; Neil J. Stone, Northwestern University Feinberg School of Medicine
• Language: English
• Date: 2015-04-07
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 by the American College of Cardiology Foundation.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jacc.2015.01.043
• Title of Journal or Parent Work: Journal of the American College of Cardiology
• ISSN: 0735-1097
• Volume: 65
• Issue: 13
• Start Page: 1361
• End Page: 1368
• Grant/Funding Information: Dr. Blaha has served on the Advisory Board of Pfizer.; Dr. Blumenthal is supported by the Kenneth Jay Pollin Professorship in Cardiology.; Dr. Martin is supported by the Pollin Cardiovascular Prevention Fellowship, Marie-Josée and Henry R. Kravis endowed fellowship, and a National Institutes of Health training grant (T32HL07024).; Dr. Gluckman has served as an expert witness for Takeda Pharmaceuticals.
• Keywords: SHARED DECISION-MAKING; shared decision making; STATIN THERAPY; Cardiovascular System & Cardiology; PREFERENCES; risk estimation; Life Sciences & Biomedicine; TRIAL; Science & Technology; cerebrovascular disease; lipid-lowering therapy; EVENTS; ACUTE MYOCARDIAL-INFARCTION; PHYSICIANS; IMPLEMENTATION; Cardiac & Cardiovascular Systems; coronary heart disease; CARE; myocardial infarction; CHOLESTEROL TREATMENT GUIDELINES

Abstract

Successful implementation of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines hinges on a clear understanding of the clinician-patient risk discussion (CPRD). This is a dialogue between the clinician and patient about potential for atherosclerotic cardiovascular disease risk reduction benefits, adverse effects, drug-drug interactions, and patient preferences. Designed especially for primary prevention patients, this process of shared decision making establishes the appropriateness of a statin for a specific patient. CPRD respects the autonomy of an individual striving to make an informedchoice aligned with personal values and preferences. Dedicating sufficient timeto high-quality CPRD offers an opportunity to strengthen clinician-patient relationships, patient engagement, and medication adherence. We review the guideline-recommended CPRD, the general concept of shared decision making and decision aids, the American College of Cardiology/American Heart Association Risk Estimator application as an implementation tool, and address potential barriers to implementation.