Drug adverse events affect patients' choices more than benefits
Central line infections in ICUs fell 58% between 2001 and 2009
Adverse events deter elderly people from taking drugs for primary prevention of myocardial infarction (MI), researchers report.
Researchers examined older persons' willingness to take medication for primary cardiovascular disease prevention according to benefits and harms by conducting in-person interviews with 356 older persons in three senior centers and one independent/assisted living facility. They reported results online Feb. 28 in the Archives of Internal Medicine.
Researchers outlined several scenarios. The first asked participants to consider that their risk for MI over the next five years was 20 in 100 and that this risk would be reduced to 14 in 100 with the medication. Subsequent scenarios varied the absolute reduction:relative risk reduction increased to 50% (risk without medication: 20 in 100; risk with medication: 10 in 100);baseline risk and relative risk reduction both increased (risk without medication: 50 in 100; risk with medication: 25 in 100) andbaseline risk decreased (risk without medication: 10 in 100; risk with medication: 7 in 100).
Most patients (88%) said they would take medication in the first scenario. Of participants who would not take it, 17% changed their preference if the absolute benefit was increased to 10 fewer persons with MI, and, of participants who would take it, 82% remained willing if the absolute benefit was decreased to 3 fewer persons with MI.
The questions were posed again with the addition of adverse effects:
- mild daily fatigue and dizziness, either severe or not severe enough to interfere with daily life;mild nausea, either severe or not severe enough to interfere with daily life andfuzzy or slowed thinking, either severe or not severe enough to interfere with daily life.
Given the risk of mild fatigue, nausea, or fuzzy thinking, 48% to 69% were unwilling or uncertain about taking medication, and only 3% would take it with adverse effects severe enough to affect functioning.
Researchers wrote that “Guidelines need to recognize that adverse effects of medications, even when mild, are not ‘side effects' but rather competing outcomes important in their own right. The decision about whether to take a medication should not be predicated on magnitude of benefit alone but rather on the balance of benefits and harms.” Further, patients need to be allowed to determine when benefits are not outweighed by harms, and their decisions should be supported even when the clinician disagrees, the authors concluded.