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Clinical Investigations: CARDIOLOGY |

Physicians’ Judgments of Survival After Medical Management and Mortality Risk Reduction Due to Revascularization Procedures for Patients With Coronary Artery Disease*

Roy M. Poses, MD; Joachim I. Krueger, PhD; Steven Sloman, PhD; Arthur S. Elstein, PhD
Author and Funding Information

*From the Brown University Center for Primary Care and Prevention (Dr. Poses), and the Division of General Internal Medicine, Memorial Hospital of Rhode Island, Pawtucket RI; the Departments of Psychology (Dr. Krueger) and Cognitive and Linguistic Sciences (Dr. Sloman), Brown University, Providence, RI; and the Department of Medical Education (Dr. Elstein) University of Illinois at Chicago, Chicago, IL.

Correspondence to: Roy M. Poses MD, Center For Primary Care and Prevention, Memorial Hospital of Rhode Island, 111 Brewster St, Pawtucket, RI, 02860; e-mail: royposes@brownvm.brown.edu



Chest. 2002;122(1):122-133. doi:10.1378/chest.122.1.122
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Study objectives: To assess the accuracy of physicians’ judgments of survival probability for medically managed patients with coronary artery disease (CAD), and of the absolute risk reduction of mortality due to coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA) for such patients; and relationships among these judgments and the physicians’ propensity to perform revascularization.

Design: Two surveys (for three-vessel or two-vessel CAD) for patients presenting with stable CAD, currently managed medically, and without other life-limiting problems. Setting: Multiple educational conferences, 1996–1997.

Participants: Conference attendees.

Measurements and results: Main outcomes were proportions of patients for whom the physicians would recommend revascularization (CABG for three-vessel CAD, CABG or PTCA for two-vessel CAD), and judgments of the proportions of medically managed patients who would be alive after 5 years, 7 years, and 11 years, and of absolute risk reduction of mortality due to CABG (or PTCA for two-vessel CAD). At least one half of the participants judged the survival rate of medically managed patients with three-vessel or two-vessel CAD to be less than the lowest rates supported by the best available evidence. More than one fourth judged the absolute risk reduction due to CABG to be higher than the highest values based on such evidence. Physicians’ propensity to perform revascularization correlated inversely with their judgments of survival given medical management, and with their judgments of absolute risk reduction due to revascularization.

Conclusions: Physicians may overuse revascularization because of excessive pessimism about survival of medically managed patients, and excessive optimism about the survival benefits of revascularization.

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