Effects of Benefits and Harms on Older Persons' Willingness to Take Medication for Primary Cardiovascular Prevention

A study of older people’s willingness to take medication to prevent cardiovascular disease according to their assessment of the medication’s benefits and harms found that their willingness to take a medication is predicated more on its harms than on its benefits.

The authors interviewed older persons in community living, asking whether they would take medication to prevent myocardial infarction (MI) with varying rates of five-year risk reduction and a range of adverse affects.

When presented with a rate of risk reduction in which six fewer people out of 100 would have MI, 88 percent of those surveyed would take the medication. Eighty-two percent of them would still take the medication if the benefit reduced to three fewer people with MI. Of those who were unwilling to take it, 17 percent would be willing with a risk reduction of 10 fewer people with MI. There were 48 to 69 percent who were unwilling to take or were unsure about taking the medication with average benefits if it caused mild fatigue, nausea or fuzzy thinking.

Guidelines and decisions about prescribing preventive medications to older patients need to balance both benefits and harms, and take into account that patients often perceive medications’ adverse effects as competing outcomes rather than as simple side effects.