HEARTFELT DECISIONS: DEVELOPMENT OF PATIENT DECISION AIDS FOR AN ACADEMIC PREVENTIVE CARDIOLOGY CLINIC

Abstract

Therapeutic Area

Preventive Cardiology Best Practices – clinic operations, team approaches, outcomes research

Background

The AHA scientific statement on shared decision making (SDM) recommends tools such as patient decision aids (PtDA) to support patients in their cardiovascular decisions. PtDAs can be used for patients indicated for additional therapy including PCSK9 inhibitors (PCSK9i). Collaboration between our health-system specialty pharmacy and the preventive cardiology clinic allows for the integration of cost-related information and patient comprehension of risk/benefit analysis into the PtDA while also utilizing the skills of a Clinical Pharmacy Specialist.

Methods

A focus group of pharmacists and cardiologists convened over several meetings to define the scope and target audience of the PtDA, overall design, and information for inclusion. A preliminary needs assessment was conducted via a survey distributed to multidisciplinary team members of physicians, nurses, and clinical pharmacists. Future steps will involve semi-structured interviews to gather patient feedback and implementing a pilot test with patients already established on PCSK9i therapy. We will evaluate the impact of PtDA through knowledge transfer questions, SURE (Sure of myself, Understand information, Risk-benefit ratio, and Encouragement) questions, and how various elements of the PtDA contributed to patients’ decision-making process.

Results

Feedback from the cardiologist focus group and multidisciplinary survey highlighted the need for decision aids in this treatment decision and generated suggestions for the format and delivery of the PtDA. As part of the initial prototypes, we have included evidence-based estimates on the benefits of PCSK9i, the degree of risk reduction, side effects, and medication costs (Figure). Cost is expressed as patient's copay at the health-system specialty pharmacy both before and after financial assistance has been applied, where applicable. Three Likert Scale questions have been included to help clarify each patients’ values and preferences. Alternative therapeutic options discussed include ezetimibe, bempedoic acid, and/or re-challenging a statin with patients with statin associated side effects.

Conclusions

Through collaborative efforts, we've developed an initial PtDA prototype to facilitate SDM for patients considering PCSK9i.