Clinicians' preferences for treatments to prevent coronary heart disease: a postal survey.

T he decision to offer treatment to prevent coronary heart disease weighs up the benefits of treatment against the disadvantages of treatment. The benefits of treatment are the product of the relative risk of treatment and pretreatment risk. Relative risk is approximately 0.7 for both aspirin and statins. As adverse effects are infrequent, the principal disadvantages of treatment are medicalisation and inconvenience. Previous research on clinicians’ preferences for preventive treatments had a number of weaknesses. Clinicians were asked to decide on their own behalf rather than for their patients. Outcome was expressed only as improvement in mortality, ignoring non-fatal outcomes. Stating only reductions in negative outcomes (loss framing) is likely to increase the uptake of a preventive intervention. No visual aids were used to illustrate risk, although these improve knowledge and encourage realistic expectations of benefits and harms. There was no test of participants’ comprehension of the information provided. This survey investigates the threshold reduction in coronary risk at which cardiologists, general practitioners, and practice nurses would offer treatment to their patients.