title: Decisions on statin therapy by patients' opinions about survival gains: cross sectional survey of general practitioners.
abstract: BACKGROUND
  Guidelines for primary prevention of cardiovascular disease provide little guidance on how patients' preferences should be taken into account. We wanted to explore whether general practitioners (GPs) are sensitive to patient preferences regarding survival gains from statin therapy.
  
  
  METHODS
  In a cross sectional, online survey 3,270 Norwegian GPs were presented with a 55 year old patient with an unfavourable cardiovascular risk profile. He expressed preferences for statin therapy by indicating a minimum survival gain that would be considered a substantial benefit. This survival gain varied across six versions of the vignette: 8, 4 and 2 years, and 12, 6 and 3 months, respectively. Participants were randomly allocated to one version only. We asked whether the GPs would recommend the patient to take a statin. Subsequently we asked the GPs to estimate the average survival gain of life long simvastatin therapy for patients with a similar risk profile.
  
  
  RESULTS
  We received 1,296 responses (40 %). Across levels of survival gains (8 years to 3 months) the proportion of GPs recommending statin therapy did not vary significantly (OR per level 1.07, 95 % CI 0.99 to 1.16). The GP's own estimate of survival gain was a statistically significant predictor of recommending therapy (OR per year adjusted for the GPs' age, sex, speciality attainment and number of patients listed 3.07, CI 2.55 to 3.69).
  
  
  CONCLUSIONS
  GPs were insensitive to patient preferences regarding survival gain when recommending statin therapy. The GPs' recommendations were strongly associated with their own estimates of survival gain.
authors.affiliation: Department of Community Medicine, UiT - The Arctic University of Norway, P.o. box 6050 Langnes, N-9037, Tromsø, Norway. peder.halvorsen@kraftlaget.no.
authors.forename: Peder A
authors.initials: PA
authors.lastname: Halvorsen
authors.affiliation: LEFO - Institute for Studies of the Medical Profession, The Norwegian Medical Association, P. box 1152 Sentrum, N-0107, Oslo, Norway. olaf.aasland@legeforeningen.no.|Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P. box 1089 Blindern, N-0318, Oslo, Norway. olaf.aasland@legeforeningen.no.
authors.forename: Olaf Gjerløw
authors.initials: OG
authors.lastname: Aasland
authors.affiliation: Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P. box 1089 Blindern, N-0318, Oslo, Norway. i.s.kristiansen@medisin.uio.no.
authors.forename: Ivar Sønbø
authors.initials: IS
authors.lastname: Kristiansen
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000401:mortality; D000066491:Clinical Decision-Making / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D058005:General Practitioners / Q000523:psychology* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009664:Norway; D010358:Patient Participation; D057240:Patient Preference; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors