PATIENT PREFERENCES FOR THROMBOLYTIC THERAPY IN ACUTE MYOCARDIAL-INFARCTION

Background. Despite extensive professional debate regarding the optima l thrombolytic therapy strategy in acute myocardial infarction (AMI), patient preferences have not been explored. Methods. Preferences among patients with known or suspected coronary artery disease for treatmen t with tissue plasminogen activator (tPA) or streptokinase (SK) for AM I were determined using a questionnaire presenting GUSTO-1 trial and d rug cost data. Preferences were based on consideration of 30-day morta lity (M) alone, hemorrhagic stroke rate (SR) alone, overall preference (M + SR), drug acquisition costs, and the estimated annual costs of u sing a single agent to treat all AMIs. Cost-related responses were pro vided under payer designations of self, third-party insurance, and fed eral government. Results. The response rate was 81% (101/125 patients) . tPA was preferred by 84%, and SK by 66%, for M alone and SR alone, r espectively (chi(2), p < 0.01). Overall preference (M + SR) favored tP A (78%, p < 0.01). tPA preference decreased to 43% considering drug ac quisition costs under the self-pay option (p < 0.01 vs M + SR). Simila r trends of lesser magnitude were also observed for the third-party an d government-payer options. Conclusions. Under conditions of zero cost and consideration of mortality plus stroke-risk data, tPA was preferr ed overall due to its lower mortality. Introduction of drug-cost data significantly shifted the preference toward SK, particularly under the self-payer designation. Patient preferences for thrombolytic therapy in AMI indicate tradeoffs between clinical attributes and cost, and sh ould assist in framing medical debate and decision making.