Utilities for major stroke: results from a survey of preferences among persons at increased risk for stroke

Am Heart J. 1998 Oct;136(4 Pt 1):703-13. doi: 10.1016/s0002-8703(98)70019-5.


Background: Patient beliefs, values, and preferences are crucial to decisions involving health care. In a large sample of persons at increased risk for stroke, we examined attitudes toward hypothetical major stroke.

Methods and results: Respondents were obtained from the Academic Medical Center Consortium (n = 621), the Cardiovascular Health Study (n = 321 ), and United Health Care (n = 319). Preferences were primarily assessed by using the time trade off (TTO). Although major stroke is generally considered an undesirable event (mean TTO = 0.30), responses were varied: although 45% of respondents considered major stroke to be a worse outcome than death, 15% were willing to trade off little or no survival to avoid a major stroke.

Conclusions: Providers should speak directly with patients about beliefs, values, and preferences. Stroke-related interventions, even those with a high price or less than dramatic clinical benefits, are likely to be cost-effective if they prevent an outcome (major stroke) that is so undesirable.

Publication types

  • Multicenter Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Attitude to Health*
  • Female
  • Health Status
  • Humans
  • Intracranial Embolism and Thrombosis / ethnology
  • Intracranial Embolism and Thrombosis / psychology*
  • Male
  • Middle Aged
  • Quality of Life
  • Sex Distribution
  • Surveys and Questionnaires
  • United States