Shared Decisions: A Qualitative Study on Clinician and Patient Perspectives on Statin Therapy and Statin‐Associated Side Effects

Author:

Ahmed Sarah T.12ORCID,Akeroyd Julia M.12,Mahtta Dhruv12ORCID,Street Richard34,Slagle Jason56,Navar Ann Marie7ORCID,Stone Neil J.8ORCID,Ballantyne Christie M.39,Petersen Laura A.12,Virani Salim S.1239ORCID

Affiliation:

1. Health Policy, Quality and Informatics Program Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations in Quality, Effectiveness, and Safety Houston TX

2. Section of Health Services Research Department of Medicine Baylor College of Medicine Houston TX

3. Section of Cardiovascular Research Department of Medicine Baylor College of Medicine Houston TX

4. Department of Communication Texas A&M University College Station TX

5. Center for Research and Innovation in Systems Safety Department of Anesthesiology Vanderbilt University School of Medicine Nashville TN

6. Geriatric Research, Education and Clinical Center Tennessee Valley Healthcare System Department of Veterans Affairs Nashville TN

7. Duke Clinical Research Institute Duke University School of Medicine Durham NC

8. Northwestern University Feinberg School of Medicine Chicago IL

9. Section of Cardiology Michael E. DeBakey Veterans Affairs Medical Center Houston TX

Abstract

Background Despite guideline recommendations and clinical trial data suggesting benefit, statin therapy use in patients with atherosclerotic cardiovascular disease remains suboptimal. The aim of this study was to understand clinician and patient views on statin therapy, statin‐associated side effects (SASEs), SASE management, and communication around statin risks and benefits. Methods and Results We conducted qualitative interviews of patients with atherosclerotic cardiovascular disease who had SASEs (n=17) and clinicians who regularly prescribe statins (n=20). We used directed content analysis, facilitated by Atlas.ti software, to develop and revise codebooks for clinician and patient interviews. The most relevant codes were “pile sorted” into 5 main topic domains: (1) SASEs vary in severity, duration, and time of onset; (2) communication practices by clinicians around statins and SASEs are variable and impacted by clinician time limitations and patient preconceived notions of SASEs; (3) although a “trial and error” approach to managing SASEs may be effective in allowing clinicians to keep patients with atherosclerotic cardiovascular disease on a statin, it can be frustrating for patients; (4) outside sources, such as the media, internet, social networks, and social circles, influence patients' perceptions and often impact the risk benefit discussion; and (5) a decision aid would be beneficial in facilitating clinician decision‐making around SASEs and discussion of SASEs with the patients. Conclusions Statin use among patients with atherosclerotic cardiovascular disease remains suboptimal because of various patient‐ and clinician‐related factors. The development of a decision aid to facilitate discussion of SASEs, clinician decision‐making, and SASE management may improve statin use in this high‐risk population.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

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