Factors Influencing Provider and Patient Choice of P2Y 12 Inhibitor Therapy

Abstract

Background:

Clopidogrel is the most commonly prescribed P2Y₁₂ inhibitor for acute coronary syndrome (ACS) or stent placement, though ticagrelor or prasugrel may be preferred. Medication-related factors may influence selection of therapy.

Objectives:

To determine which factors most greatly influence cardiology-provider and patient selection of P2Y₁₂ inhibitor to guide shared-decision making (SDM).

Methods:

Single-center study assessed survey responses from 32 cardiology-providers who prescribed and 105 patients who received clopidogrel, prasugrel, or ticagrelor for ACS or stent placement. Respondents ranked factors influencing P2Y₁₂ inhibitor selection and reported preference of therapy. Patients reported experience with shared decision-making process.

Results:

Cardiology-providers ranked risk of bleeding, comfort/experience, and cost as most influential. Patients ranked risk of drug interaction, adverse effects, and reduction in myocardial infarction as most influential. Significant differences between cardiology-providers and patients were found for 5 of 8 factors. Cardiology-providers ranked once daily administration (p = 0.01), risk of bleeding (p = 0.002), and cost (p < 0.001) as more important than patients. Patients ranked risk of adverse effects (p = 0.007) and drug interactions (p = 0.005) as more important than cardiology-providers. Cardiology-providers prescribed ticagrelor 42.3% of the time following ACS, though 78.1% ranked it as their preferred agent. Patients were prescribed ticagrelor 9.3% of the time, though 55.7% ranked it as their preferred agent. Use of SDM was reported by 21.6% of patients and 88.5% were unaware that multiple P2Y₁₂ inhibitors existed.

Conclusion:

Significant differences exist between cardiology-providers and patients regarding factors influencing P2Y₁₂ inhibitor selection, specifically safety-related factors, once daily administration, and cost. Most patients were not involved in SDM.