The Treatment-Risk Paradox: More Complex Than We Think

Evidence reveals that patients at highest risk for poor outcomes are less likely than those at low risk to receive appropriate therapy, a phenomenon termed the “treatment-risk paradox.” In a prospective cohort study, researchers looked at use of guideline-recommended medications in patients with angiographically proven coronary heart disease, with a focus on functional capacity and depressive symptoms (factors likely to “fly under the radar” because they are not coded).

One month after catheterization, nearly 4000 patients reported on their medication use and completed three standardized questionnaires about functional capacity, quality of life, and depressive symptoms. High-risk patients were less likely than low-risk patients to be taking …