Fried Terri R, Tinetti Mary E, Towle Virginia, O'Leary John R, Iannone Lynne
Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Arch Intern Med. 2011 May 23;171(10):923-8. doi: 10.1001/archinternmed.2011.32. Epub 2011 Feb 28.
Quality-assurance initiatives encourage adherence to evidenced-based guidelines based on a consideration of treatment benefit. We examined older persons' willingness to take medication for primary cardiovascular disease prevention according to benefits and harms.
In-person interviews were performed with 356 community-living older persons. Participants were asked about their willingness to take medication for primary prevention of myocardial infarction (MI) with varying benefits in terms of absolute 5-year risk reduction and varying harms in terms of type and severity of adverse effects.
Most (88%) would take medication, providing an absolute benefit of 6 fewer persons with MI out of 100, approximating the average risk reduction of currently available medications. 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. In contrast, large proportions (48%-69%) were unwilling or uncertain about taking medication with average benefit causing mild fatigue, nausea, or fuzzy thinking, and only 3% would take medication with adverse effects severe enough to affect functioning.
Older persons' willingness to take medication for primary cardiovascular disease prevention is relatively insensitive to its benefit but highly sensitive to its adverse effects. These results suggest that clinical guidelines and decisions about prescribing these medications to older persons need to place emphasis on both benefits and harms.
质量保证倡议鼓励根据对治疗益处的考量遵循循证指南。我们根据益处和危害研究了老年人服用预防原发性心血管疾病药物的意愿。
对356名社区居住的老年人进行了面对面访谈。询问参与者对于服用预防心肌梗死（MI）药物的意愿，这些药物在5年绝对风险降低方面有不同益处，在不良反应的类型和严重程度方面有不同危害。
大多数人（88%）愿意服药，若每100人中有6人因服药而减少患MI的情况，这接近目前可用药物的平均风险降低水平。在不愿服药的参与者中，如果绝对益处增加到每100人中有10人减少患MI，17%的人改变了他们的偏好；而在愿意服药的参与者中，如果绝对益处减少到每100人中有3人减少患MI，82%的人仍然愿意服药。相比之下，很大一部分人（48%-69%）不愿意或不确定是否服用会导致轻度疲劳、恶心或思维模糊等平均益处的药物，只有3%的人会服用不良反应严重到足以影响功能的药物。
老年人服用预防原发性心血管疾病药物的意愿对其益处相对不敏感，但对其不良反应高度敏感。这些结果表明，关于向老年人开具这些药物的临床指南和决策需要同时强调益处和危害。
