Eliciting Patient Preferences Towards Treatment for Coronary Artery Disease

Summary

Coronary artery disease (CAD) is a leading cause of disability and death in Canada. Bypass surgery and procedures using balloons and stents to open up blocked vessels are two widely used treatment options for patients with multivessel CAD, and have been shown to improve patient outcomes compared to therapy with medications alone. Clinical practice guidelines have recommended surgery for managing multi-vessel disease in most cases, but increasingly suggest a shared-decision making approach. This is because there is substantial uncertainty about the best treatment approach for stable multivessel disease for many patients, especially in the elder and those living with multimorbidity, which are associated with higher procedural complication risks. Consequently, treatment decisions for these patients with CAD are usually based on Heart Team discussions, which involve discussions among clinical experts about the trade-offs in outcomes associated with different treatment strategies, variability in levels of accepted risk by patients, and institutional clinical practice cultures. These Heart Team discussions are intended to arrive at the best decision for each patient, but explicit risk information is rarely provided to patients nor are patient preferences formally incorporated within the current decision-making process. There is a limited understanding of patients’ preferences towards the different treatment options for patients with stable multivessel disease and how patients' preferences influence shared decision- making for disease management. This study will elicit patient preferences towards these treatment options and develop personalized approaches to communicate the benefit and risk associated with each treatment option to patients. The knowledge gained through this research will be used to support processes and practices for shared decision-making between patients and Heart Teams and ensure delivery of the right treatment to the right patient at the right time.