Distribution of lifespan gain from primary prevention intervention

Finegold, J. A., Shun-Shin, M. J., Cole, G. D., Zaman, S., Maznyczka, A. M., Zaman, S., Al-Lamee, R., Ye, S. and Francis, D. P. (2016) Distribution of lifespan gain from primary prevention intervention. Open Heart, 3(1), e000343. (doi: 10.1136/openhrt-2015-000343) (PMID:27042321) (PMCID:PMC4800759)

Abstract

Objective: When advising patients about possible initiation of primary prevention treatment, clinicians currently do not have information on expected impact on lifespan, nor how much this increment differs between individuals. Methods: First, UK cardiovascular and non-cardiovascular mortality data were used to calculate the mean lifespan gain from an intervention (such as a statin) that reduces cardiovascular mortality by 30%. Second, a new method was developed to calculate the probability distribution of lifespan gain. Third, we performed a survey in three UK cities on 11 days between May–June 2014 involving 396 participants (mean age 40 years, 55% male) to assess how individuals evaluate potential benefit from primary prevention therapies. Results: Among numerous identical patients, the lifespan gain, from an intervention that reduces cardiovascular mortality by 30%, is concentrated within an unpredictable minority. For example, men aged 50 years with national average cardiovascular risk have mean lifespan gain of 7 months. However, 93% of these identical individuals gain no lifespan, while the remaining 7% gain a mean of 99 months. Many survey respondents preferred a chance of large lifespan gain to the equivalent life expectancy gain given as certainty. Indeed, 33% preferred a 2% probability of 10 years to fivefold more gain, expressed as certainty of 1 year. Conclusions: People who gain lifespan from preventative therapy gain far more than the average for their risk stratum, even if perfectly defined. This may be important in patient decision-making. Looking beyond mortality reduction alone from preventative therapy, the benefits are likely to be even larger.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Maznyczka, Dr Annette Marie
• Authors: Finegold, J. A., Shun-Shin, M. J., Cole, G. D., Zaman, S., Maznyczka, A. M., Zaman, S., Al-Lamee, R., Ye, S., and Francis, D. P.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Open Heart
• Publisher: BMJ Publishing Group
• ISSN: 2053-3624
• ISSN (Online): 2053-3624
• Copyright Holders: Copyright © 2016 Finegold JA, Shun-Shin MJ, Cole GD, et al.
• First Published: First published in Open Heart 3(1):e000343
• Publisher Policy: Reproduced under a Creative Commons License