The CV Primary Prevention Choice tool is under construction for integration within electronic medical record systems and implementation in primary care settings. An NIH-funded hybrid implementation trial is underway led by Dr. Jennifer Ridgeway.
LEGACY TOOLS (No longer necessarily up-to-date)
Statin/Aspirin Choice Decision Aid
The risk reductions attributed to statins and decision aids come from systematic reviews of randomized trials of primary prevention of coronary events with statins (25-30% reduction in risk of coronary events) and aspirin (15-20% reduction in coronary events).
The risk reduction in coronary events with fixed standard dose statins (atorvastatin 10 mg, simvastatin 40 mg, pravastatin 40 mg, rosuvastatin 5 mg) has been stable for years and was recently documented in a systematic review to be 25%, with high dose statins (2-3 times standard dose) adding about 15% relative risk reduction (i.e., 40% risk reduction).
Low-dose aspirin can reduce coronary events by about 20-25% and can impact the risk and outcomes of colon cancer and other cancers.
Tools:
Risk calculators:
- Framingham: 10-year Coronary Heart Disease Risk – Wilson et al (1998)
- DAgostino 1994: Formula for stroke risk
- Reynolds Risk Score
- ACC/AHA Pooled Cohort Calculator
Decision aids to be used during the encounter:
- Statin Choice tool
Key Assumptions:
- The risk reductions attributed to statins and decision aids come from systematic reviews of randomized trials of primary prevention of coronary events with statins (25-30% reduction in risk of coronary events) and aspirin (15-20% reduction in coronary events).
- The risk reduction in coronary events with fixed standard dose statins (atorvastatin 10 mg, simvastatin 40 mg, pravastatin 40 mg, rosuvastatin 5 mg) has been stable for years and was recently documented in a systematic review to be 25%, with high dose statins (2-3 times standard dose) adding about 15% relative risk reduction (i.e., 40% risk reduction).
Decision aids in practice:
Additional resources:
Statin/Aspirin Choice
Decision aids used in a 98-patient randomized trial (specialty care and independently by another group in a primary care clinic in New York) publications:
- Nannenga MR, Montori VM, Weymiller AJ, et al. A treatment decision aid may increase patient trust in the diabetes specialist. The Statin Choice randomized trial. Health Expect 2009;12:38-44.
- Jones LA, Weymiller AJ, Shah, N. Should clinicians deliver decision aids? Further exploration of the Statin Choice randomized trial results. Med Decis Making 2009;29:468-474.
- Weymiller AJ, Montori VM, Jones LA, et al. Helping patients with type 2 diabetes mellitus make treatment decisions: Statin Choice randomized trial. Arch Intern Med 2007;167:1076-1082.
- Montori VM, Breslin M, Maleska M, Weymiller AJ. Creating a conversation: Insights from the development of a decision aid.PLoS Med 2007;4(8):233.
- Mann DM, Ponieman D, Montori VM, Arciniega J, McGinn T. The Statin Choice decision aid in primary care: a randomized trial. Patient Educ Couns 2010; 80: 138-140.
NIH-funded Decision Aids in Diabetes (DAD) trial publications:
- Ruud KL, Leblanc A, Mullan RJ, Pencille LJ, Tiedje K, Branda ME, Van Houten HK, Heim SR, Kurland M, Shah ND, Yawn BP, Montori VM. Lessons learned from the conduct of a multisite cluster randomized practical trial of decision aids in rural and suburban primary care practices. Trials. 2013 Aug 21;14(1):267.
- Branda ME, LeBlanc A, Shah ND, Tiedje K, Ruud K, Van Houten H, Pencille L, Kurland M, Yawn B, Montori VM.Shared decision making for patients with type 2 diabetes: a randomized trial in primary care. BMC Health Serv Res. 2013 Aug 8;13:301. doi: 10.1186/1472-6963-13-301.
- Tiedje K, Shippee ND, Johnson AM, Flynn PM, Finnie DM, Liesinger JT, May CR, Olson ME, Ridgeway JL, Shah ND, Yawn BP, Montori VM. ‘They leave at least believing they had a part in the discussion’: Understanding decision aid use and patient-clinician decision-making through qualitative research. Patient Educ Couns. 2013 Apr 15. doi:pii: S0738-3991(13)00122-5. 10.1016/j.pec.2013.03.013.
- LeBlanc A, Ruud KL, Branda ME, Tiedje K, Boehmer KR, Pencille LJ, Van Houten H, Matthews M, Shah ND, May CR, Yawn BP, Montori VM. The impact of decision aids to enhance shared decision making for diabetes (the DAD study): protocol of a cluster randomized trial. BMC Health Serv Res. 2012 May 28;12:130. doi: 10.1186/1472-6963-12-130.
Aspirin Choice
- Kent DM, Shah ND. Personalizing evidence-based primary prevention with aspirin: Individualized risks and patient preferences. Circ Cardiovasc Qual Outcomes 2011;4:260-262.
DISCLAIMER: No decision aid replaces the conversation patients should have with their clinicians to make important, clinical decisions. Use of these decision aids carries no liability to its developers or to the Mayo Clinic Foundation for Education and Research.
Feedback
If you download our decision aids, we would love to hear from you! Please send us a note at kerunit@mayo.edu to let us know who you are, why you are interested in the decision aid(s), and how you plan to use them. Remember to check back to this page periodically to make sure you are using the most up-to-date version(s).