Patients' preferences for coronary revascularization: a systematic review

Aims: Current recommendations regarding the best treatment option for coronary revascularization are usually based on composite outcomes that were not selected or weighed with patients thence they may fail in representing patients' preferences adequately. This systematic review aimed to appraise existing literature surrounding stated preference (SP) regarding coronary revascularization. Methods and results: Studies related to SP regarding coronary revascularization were searched on Medline, Embase and Lilacs databases. Two reviewers screened all titles independently, and consensus resolved any disagreements. Of 735 total citations, six studies were included and qualitatively synthesized. Notably, the attributes most often cited in these studies coincided with those already used in clinical trials (death, myocardial infarction, stroke and redo revascularization). Half of the studies analyzed the use of composite endpoints and showed the necessity to review this practice since the attributes are weighed differently, and there is a disagreement between patients and physicians. Also, a large variety of methods were used to elicitate and value the attributes such as rating, ranking, standard gamble, willingness to pay, and discrete choice experiments. Conclusion: Despite a large number of studies comparing revascularization treatment efficacy, there are just a few focusing on patients' preferences. The selection of outcomes to be considered in the trade-off between treatment options and how to weigh them properly, taking into consideration patients' preferences, need to be explored in future trials.