Older Patients' Willingness to Take Heart Medication Shaped by Fear of Side Effects

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Evidence-based guidelines focus on reducing the risk of disease-specific outcomes such as myocardial infarction (MI) or stroke. Elderly patients will often forgo medications from fear of developing side effects, even ones as mild as fatigue, nausea and fuzzy thinking, according to a report by Yale School of Medicine researchers.

Terri R. Fried, M.D., professor of internal medicine/geriatrics at Yale School of Medicine, and the VA Connecticut Healthcare System, and colleagues findings have been published online in the Archives of Internal Medicine, and will be published in the June 27 print issue of the journal.

To evaluate older persons' willingness to take a medication for primary prevention of cardiovascular disease based on its benefits and harms, the researchers conducted in-person interviews with 356 people living in the community who were age 65 years or older.

The participants were asked about their willingness to take medication for primary prevention of a heart attack (or MI) with varying benefits in terms of absolute 5-year risk reduction and varying harms in terms of type and severity of adverse effects.

"These patients are willing to take medications for cardiovascular disease prevention, but only if they are not linked to what are generally considered to be acceptable side effects," said first author Terri R. Fried, M.D., professor of internal medicine/geriatrics at Yale School of Medicine, and the VA Connecticut Healthcare System.

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Most participants (88%) said they would take the medication if it provided an absolute benefit of 6 fewer persons with MI out of 100, approximating the average risk reduction of currently available medications and had no adverse side effects.

Of the participants who would not take it, 17% changed their preference if the absolute benefit was increased to 10 fewer persons with MI and had no adverse side effects.

Of participants who would take the medication, 82% remained willing if the absolute benefit was decreased to 3 fewer persons with MI and there were no adverse side effects.

In contrast, large proportions (48 – 69%) were unwilling or uncertain about taking such medication if it caused mild fatigue, nausea, or fuzzy thinking. Only 3% would take medication with adverse effects severe enough to affect daily functioning.

"Our results show that these 'side effects,' more aptly considered as adverse events, are as important to older persons as the medication's benefits, and need to be considered important outcomes in their own right," said Fried.

The study was supported by a grant from the Robert Wood Johnson Foundation and by the Claude D. Pepper Older Americans Independence Center at Yale School of Medicine. Fried is supported by a grant from the National Institutes of Health/National Institute on Aging.

Source
Terri R. Fried; Mary E. Tinetti; Virginia Towle; John R. O'Leary; Lynne Iannone; Effects of Benefits and Harms on Older Persons' Willingness to Take Medication for Primary Cardiovascular Prevention; Arch Intern Med. 2011;0(2011):archinternmed.2011.32.

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