Fear of side effects shapes older patients' willingness to take heart medication

Faced with the risk of developing side effects, even ones as mild as fatigue, nausea and fuzzy thinking, many older patients are willing to forego medications that provide only average benefit in preventing heart attack, according to a report by Yale School of Medicine researchers.

'These patients are willing to take medications for cardiovascular disease prevention, but only if they are not linked to what are generally considered to be acceptable side effects,' said first author Terri R. Fried, M.D., professor of internal medicine/geriatrics at Yale School of Medicine, and the VA Connecticut Healthcare System.

The report by Fried and co-authors is available online in the Archives of Internal Medicine, and will be published in the June 27 print issue of the journal.

Clinical practice guidelines recommend medications for primary prevention based on the patient's risk for developing an illness and the likelihood that the medication will reduce this risk. But Fried and her team suspected that this might not be consistent with how older persons think about the benefit and harms of medications.

To find out, the team evaluated older persons' willingness to take a medication for primary prevention of cardiovascular disease based on its benefits and harms. They conducted in-person interviews with 356 people living in the community who were age 65 years or older.

The participants were asked about their willingness to take medication for primary prevention of heart attack (myocardial infarction).

Most participants (88 percent) said they would take the medication if it had no adverse effects and offered about the average risk reduction of currently available medications. In contrast, large proportions (48 to 69 percent) were unwilling or uncertain about taking such medication if it caused mild fatigue, nausea, or fuzzy thinking, and only 3 percent would take medication with adverse effects severe enough to affect daily functioning.

'Our results show that these 'side effects,' more aptly considered as adverse events, are as important to older persons as the medication's benefits, and need to be considered important outcomes in their own right,' said Fried.