Myocardial infarction

A myocardial infarction (MI), commonly known as a ‘heart attack’ occurs when a portion of the heart is deprived of oxygen due to blockage of a coronary artery. Without oxygen, muscle cells served by the blocked artery begin to die (infarct). As a heart attack can be fatal, it is crucial to seek emergency help soon after symptoms present. The heart attack or blockage of the artery is due to the buildup of fats, cholesterol and other substances in the body and artery walls, which may also lead to a stroke (due to loss of blood flow to the brain) or fatal events.

Clinical treatment guidelines focus on several factors, including the timing of treatment during the course of clinical care, i.e. whether drugs should be administered soon after the heart attack is diagnosed (an acute phase) or at more chronic stages of disease. Treatments for a heart attack may also cause the risk of severe bleeding including risk of bleeding in the skull or other severe bleeding events.

Knowledge of whether patients with acute or chronic disease have different preferences (i.e., willingness to accept higher probability of side effects in exchange for higher efficacy) could inform decision-making by developers, regulators, payers, and clinicians at point of care; it would allow for a patient-centered assessment of which treatment options may be more suitable (i.e., have a more favorable benefit-risk profiles) in these two phases of disease.


Pinto, C.A., Chua, G.N., Bridges, J.F.P. et al. Comparing Patient Preferences for Antithrombotic Treatment During the Acute and Chronic Phases of Myocardial Infarction: A Discrete-Choice Experiment. Patient (2021).

Tervonen, T., Prawitz, T., Chua, G.N., Hyacinthe, J., Pinto, C.A., Net clinical benefit of antiplatelet therapy was affected by patient preferences: A personalized benefit-risk assessment, Journal of Clinical Epidemiology (2022) Vol 144, pp 84-92.


Therapeutic area: Myocardial infarction

Study led by: MSD

PREFER leads team: Cathy Anne Pinto

MPLC decision point of interest: Post-marketing, Pre-marketing: future developments

PREFER case study acronym: MSD

Clinical objectives: To compare patient preferences for antithrombotic treatment attributes for patients with an acute MI and patients with chronic disease. To assess preference heterogeneity in other relevant subgroups.

Patients from: United Kingdom, Acute MI patients recruited by NHS clinical sites,
Chronic patients recruited via patient panels

Methods in Qualitative study: Semi-structured interviews

Methods in Quantitative study:Discrete Choice Experiment (DCE), Best-worst Scaling Case 1

End-date qualitative data collection: June 2018

End-date quantitative data collection: Target: May 2020


A myocardial infarction, or what is commonly known as a ‘heart attack’, happens when the large blood vessels that support the heart (known as the coronary arteries) are blocked and a part of the heart is deprived of oxygen. The blockage of your arteries is caused by a buildup of blood fats (cholesterol) and other substances in the artery walls. Without oxygen, muscle cells in the heart begin to die, which means you need to have medical treatment as soon as possible.

In this study, we asked more than 300 patients about their preferences- approximately half in the acute stage and half in the chronic stage of their disease. Most of them were men, on average, 64 years old. Many of the patients also had other medical conditions, like high cholesterol, high blood pressure, or diabetes, and several of them had already used medicines that thin the blood. All patients had been hospitalized after a heart-attack, they were over 18 and living in England. We asked them about their preferences when it comes to heart attack medications. Hoping to find how much value a person gives different risks and benefits of a particular treatment, and how they balance between them.

Treating heart attacks

Pinto, CA & Tervonen, T. Treating heart attacks with blood thinners: What do patients PREFER?, Zenodo. 2022. DOI: 10.5281/zenodo.5840266






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The Patient Preferences in Benefit-Risk Assessments during the Drug Life Cycle (PREFER) project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 115966. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and the European Federation of Pharmaceutical Industries and Associations (EFPIA).