Methods: A cross-sectional survey of cardiologists and their consulting patients with HF was conducted in 10 countries (Argentina, Brazil, China, Colombia, France, Japan, Mexico, Russia, Saudi Arabia and Turkey). Patient record forms (PRFs) were completed by cardiologists for consecutively consulting patients with HF, who were then invited to complete a patient self-completion questionnaire (PSC). Only responses from PRFs with an associated PSC were analyzed. Patients and cardiologists reported the degree of patient input into treatment decisions and the side effects experienced as a result of the patient’s current HF treatment regimen; these were compared, and concordance calculated. Responses were also analyzed by taking the patient perspective and evaluating how often a patient-reported side effect was not recognized in the PRF (cardiologist under-reporting) and vice versa (cardiologist over-reporting).
Results: Almost one third (30%) of patients were not consulted on their choice of therapy. For 65% of patients, a discussion occurred with the cardiologist having the final call, while for 6% of patients a discussion occurred but the patient had the final call. A high level of concordance (74%) between matched cardiologist and patient pairs (n = 2228) was observed for the degree of patient input into treatment decisions. Concordance was also high between matched cardiologist and patient pairs (n = 2385) for the occurrence of side effects, ranging from 77% (fatigue/tiredness) to 98% (gout, rash and swelling of lips, tongue, throat or face) (Figure). Individual side effects were reported by 1–22% of patients (Figure). Cardiologists more often under- than over-reported the occurrence of side effects of treatment reported by patients (Figure).
Conclusions: Shared decision-making is the pinnacle of patient-centred care whereby the physician educates the patient about treatment options, possible outcomes and side effects, in order to reach an informed treatment decision. This process could be considered fundamental to an overall improvement of patient care. In this study, we observed that almost one third of patients were not at all involved in decisions about their HF treatment, and, when they were, the ultimate decision was not made in partnership between the patient and cardiologist. Side effects experienced by patients as a result of their HF treatment regimen were more frequently under-reported than over-reported by their cardiologists. Improved communication between patients and cardiologists is essential to optimize treatment decision-making and to increase awareness of, and concordance with, the occurrence of treatment side effects.