Reduce Mortality Risk Above All Else: A Discrete-Choice Experiment in Acute Coronary Syndrome Patients

Background and Objective Cardiovascular disease is the main cause of death in Germany and other industrialized countries. However, until now, little has been known about how people with acute coronary syndrome (ACS) value aspects of their medical treatment. The objective of this study was to evaluate patients' preferences regarding different antiplatelet medication options following an ACS. Method After identification of patient-relevant treatment attributes (a literature review and qualitative interviews), a discrete-choice experiment (DCE) including five patient-relevant attributes was conducted. The DCE used a forced-choice approach in which no opt out was present, as no treatment is not an option after ACS. The attribute and level combinations were created using a fractional-factorial NGene design with priors. Data analysis was performed using a random-effects logit model. An additional generalized linear latent and mixed models (GLLAMM) analysis was performed to evaluate subgroup differences. Results ACS patients (N = 683) participated in computer-assisted personal interviews. Preference analysis showed a clear dominance of the attribute mortality risk (coefficient: 0.803). Ranked second was side effect: dyspnea (coefficient: 0.550) followed by risk of a new myocardial infarction (coefficient: 0.464) and side effect: bleeding (coefficient: 0.400). Frequency of intake was less important (coefficient: 0.025). Within the 3-class GLLAMM, the variables marital status (p = 0.008), highest level of education (p = 0.003), and body-mass index (according to World Health Organization cluster; p = 0.014) showed a significant impact on the estimated class probabilities. Conclusion Our study found mortality risk to be of the highest value for patients. Patient-centered care and decision making requires consideration of patient preferences; moreover, the information on preferences can be used to develop effective therapies after an ACS. The data generated will enable healthcare decision makers and stakeholders to understand patient preferences to promote patients' benefit.