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Relationship between universal health outcome priorities and willingness to take medication for primary prevention of myocardial infarction.

Case SM, O'Leary J, Kim N, Tinetti ME, Fried TR. Relationship between universal health outcome priorities and willingness to take medication for primary prevention of myocardial infarction. Journal of the American Geriatrics Society. 2014 Sep 1; 62(9):1753-8.

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Abstract:

OBJECTIVES: To determine how well universal health outcome priorities represent individuals' preferences in specific clinical situations. DESIGN: Observational cohort study. SETTING: Community. PARTICIPANTS: Community-dwelling adults aged 65 and older (N  =  357). MEASUREMENTS: Participants used three tools assessing universal health outcome priorities related to two common trade-offs: quality versus quantity of life and future health versus present inconveniences and burdens of treatment. The tools' ability to identify participants who were unwilling to take a medication that reduced the risk of myocardial infarction but caused dizziness and fatigue was analyzed. RESULTS: There were consistent and significant associations between unwillingness to take the medication and prioritizing quality of life or future health for all three tools in the expected direction (P  <  .05). Despite these associations, the positive (PPV) and negative predictive values for the tools were generally modest (0.49-0.83). The tool with the most specific statements resembling the medication scenario had the best specificity (0.97) and PPV (0.83). CONCLUSION: Universal health outcome priorities only modestly identified older persons who would be unwilling to take a medication for primary prevention of myocardial infarction that causes adverse effects. Although tools that are the most general in their assessment of priorities have the benefit of being applicable across the widest range of scenarios, tools with greater specificity may be necessary to inform individual treatment decisions.




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