Distribution of lifespan gain from primary prevention intervention
Distribution of lifespan gain from primary prevention intervention
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DOI：
10.1136/openhrt-2015-000343
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发表时间：
2016-05-01
期刊：
影响因子：
2.7
通讯作者：
Francis, Darrel P.
中科院分区：
文献类型：
--
作者：
Finegold, Judith A.;Shun-Shin, Matthew J.;Francis, Darrel P.
目的：当建议患者可能开始的一级预防治疗，临床医生目前没有预期的影响寿命的信息，也没有多少这种增量不同individuals.Methods：首先，英国心血管和非心血管死亡率的数据被用来计算平均寿命增益从干预（如他汀类药物），降低心血管死亡率的30%。其次，提出了一种计算寿命增长概率分布的新方法。第三，我们进行了一项调查，在三个英国城市之间的11天，2014年5月至6月，涉及396名参与者（平均年龄40岁，55%男性），以评估个人如何评估潜在的好处，从一级预防therapy.Results：在众多相同的患者，寿命增益，从干预，降低心血管死亡率30%，集中在一个不可预测的少数。例如，具有全国平均心血管风险的50岁男性平均寿命增加7个月。然而，这些相同的个体中有93%没有获得寿命，而其余7%的平均寿命为99个月。许多受访者更喜欢大的寿命增长的机会，而不是作为确定性的同等预期寿命增长。事实上，33%的人更喜欢10年的概率为2%，以5倍以上的收益，表示为确定性的1 year.Conclusions：人谁获得寿命从预防性治疗获得远远超过平均水平的风险层，即使完美定义。这对患者的决策可能很重要。除了预防性治疗降低死亡率之外，其益处可能更大。
Objective: When advising patients about possible initiation of primary prevention treatment, clinicians currently do not have information on expected impact on lifespan, nor how much this increment differs between individuals.Methods: First, UK cardiovascular and non-cardiovascular mortality data were used to calculate the mean lifespan gain from an intervention (such as a statin) that reduces cardiovascular mortality by 30%. Second, a new method was developed to calculate the probability distribution of lifespan gain. Third, we performed a survey in three UK cities on 11 days between May-June 2014 involving 396 participants (mean age 40 years, 55% male) to assess how individuals evaluate potential benefit from primary prevention therapies.Results: Among numerous identical patients, the lifespan gain, from an intervention that reduces cardiovascular mortality by 30%, is concentrated within an unpredictable minority. For example, men aged 50 years with national average cardiovascular risk have mean lifespan gain of 7 months. However, 93% of these identical individuals gain no lifespan, while the remaining 7% gain a mean of 99 months. Many survey respondents preferred a chance of large lifespan gain to the equivalent life expectancy gain given as certainty. Indeed, 33% preferred a 2% probability of 10 years to fivefold more gain, expressed as certainty of 1 year.Conclusions: People who gain lifespan from preventative therapy gain far more than the average for their risk stratum, even if perfectly defined. This may be important in patient decision-making. Looking beyond mortality reduction alone from preventative therapy, the benefits are likely to be even larger.