Societies stress shared decision making in updated lipids performance measures
Better patient outcomes are realized only if patients agree with, act on, and adhere to their doctors' advice for 5 to 10 years, but up to half of patients stop statins at 1 to 2 years.
The American College of Cardiology and American Heart Association based the updated measures on the secondary prevention recommendations of the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. They were published online Dec. 14 in the Journal of the American College of Cardiology and Circulation.
The document includes 5 measures, 4 of which are revisions of lipid management measures appearing in 4 existing measure sets: peripheral artery disease, ST-elevation and non-ST-elevation myocardial infarction, percutaneous coronary intervention, and coronary artery disease and hypertension. The fifth measure is new and applies to patients with clinical atherosclerotic cardiovascular disease. The new measures introduce the concept of shared decision making into the performance measures to change the focus from recommending and prescribing statins based on evidence to promoting choice by an informed patient.
“The recommendation to initiate statins for secondary prevention is based on strong evidence in which benefit far exceeds risk. However, better patient outcomes are realized only if patients agree with, act on, and adhere to the recommendation for 5 to 10 years,” the document states. It continues that most patients who are prescribed statins for secondary prevention begin treatment, but up to half have stopped statins at 1 to 2 years.
The writing committee explained that physicians should engage patients in making decisions about their care using tools to promote, facilitate, and measure shared decision making.
“Clinicians need to embrace the concept that evidence-based medicine and guidelines alone are not sufficient to make a recommendation or decision; rather, the evidence has to be considered from the viewpoint of what matters to individual patients,” the document states. “Hence, the clinical encounter transforms from one where the clinician strives to convince the patient of the ‘right answer’ to one where the clinician and patient collaborate, deliberate, and arrive at the ‘best answer’ that fits patient preferences, values, and context.”