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Clinicians’ preferences for treatments to prevent coronary heart disease: a postal survey
  1. S Bryan1,
  2. P Gill2,
  3. S Greenfield2,
  4. K Gutridge3,
  5. T Marshall3,
  6. Birmingham Patient Preferences Group
  1. 1Health Services Management Centre, University of Birmingham, Birmingham, UK
  2. 2Department of Primary Care and General Practice, University of Birmingham
  3. 3Department of Public Health & Epidemiology, University of Birmingham
  1. Correspondence to:
    Dr Tom Marshall
    Department of Public Health & Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK;

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The 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 pre-treatment 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.1 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.


A list of physicians with an interest in cardiology was obtained from the West Midlands region of the Royal College of Physicians. A list of practice nurses with an interest in cardiology and a list of general practitioners were obtained from a previous survey. A random …

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  • The research was funded by a grant from the Medical Research Council (G0001097). Additional support was provided by the Primary Care Clinical Research and Trials Unit, University of Birmingham. Acknowledgements are due to all the clinicians and other primary care staff who took part in this study, gave their time or made it possible.