Nine in ten cardiology visits, and the patient never really had a say.
In the quiet space between doctor and patient, a decision is being made — but in nine out of ten cardiology consultations, only one voice is truly shaping it. The American Heart Association, publishing in Circulation, has named this silence as a crisis: shared decision-making, despite over a hundred trials affirming its value, reaches fewer than ten percent of clinical encounters. The statement is less a set of prescriptions than a call to reimagine the consultation itself — as a meeting of two forms of knowledge, where the patient's values are not a footnote but a foundation.
- Despite more than a hundred clinical trials confirming its benefits, shared decision-making is absent from roughly 90% of cardiology consultations — a gap the AHA now calls a foundational failure of care.
- The stakes are especially high in cardiovascular medicine, where choices between longevity and quality of life are deeply personal and the consequences of one-sided decisions can be irreversible.
- The AHA's statement dissects why the gap persists: clinicians are reimbursed for speed, not conversation, and most lack training in the culturally sensitive communication that genuine shared decision-making demands.
- Proposed remedies target the system as much as the individual — embedding decision-support tools in electronic health records, shifting toward team-based care, and reforming reimbursement to reward time spent with patients.
- The statement draws on councils spanning nursing, cardiology, stroke, and beyond, signaling that the AHA regards this not as a specialty concern but as a structural reckoning for medicine at large.
Walk into a cardiology appointment today and the odds are nine in ten that the conversation will be one-sided. A treatment path will be chosen — but not together. That quiet imbalance is the crisis at the center of a new scientific statement from the American Heart Association, published in Circulation.
The statement is not a treatment guideline. It is a case for changing how doctors and patients talk. The approach it champions — shared decision-making — asks that patients receive honest, balanced information about their options; that clinical expertise be translated into terms relevant to the individual's actual life; and that the patient's own values, fears, and acceptable trade-offs be treated as genuine inputs into the final decision, not afterthoughts.
More than a hundred clinical trials support this model, consistently showing that patients who experience it understand their condition better, accept their treatment more readily, and report higher satisfaction. And yet it occurs in as few as ten percent of consultations across specialties. In cardiology, where decisions about longevity versus quality of life are deeply personal, that gap is particularly striking.
The AHA statement also confronts why the number stays so low. Clinicians are incentivized for speed, not conversation. Decision-support tools are rarely available at the point of care. And communication training seldom accounts for the cultural, linguistic, and racial backgrounds that shape how patients receive and process information. Shared decision-making, the statement makes clear, is not a script — it requires meeting each patient where they are.
Proposed solutions span reimbursement reform, integration of decision aids into electronic health records, team-based care models, and clinician training overhauls. The statement was shaped by AHA councils covering cardiology, nursing, stroke, hypertension, and more — a breadth that signals this is seen as a foundational issue, not a niche one. What remains to be seen is whether the structural changes required will gain the traction needed to move that ten-percent figure.
Walk into a cardiology appointment today and the odds are roughly nine in ten that the conversation will be one-sided. The doctor will speak. The patient will listen. A treatment path will be chosen — but not together. That is the quiet crisis at the center of a new scientific statement from the American Heart Association, published this month in the journal Circulation.
The statement is not a set of treatment guidelines. It is something more foundational: a case for changing how doctors and patients talk to each other. The concept it champions is called shared decision-making — a structured approach in which patients are given clear, unbiased information about their options, clinicians bring their expertise to bear in ways that are actually relevant to the individual in front of them, and the patient's own values, goals, and preferences are treated as legitimate inputs into the final decision, not afterthoughts.
The evidence behind this approach is substantial. More than a hundred clinical trials have shown that when shared decision-making happens, patients come away with a better understanding of their condition, greater acceptance of their treatment, and higher satisfaction with their care. That is a consistent finding across a wide range of health care settings. And yet, despite that body of evidence, genuine shared decision-making takes place in as few as ten percent of face-to-face clinical consultations across specialties. In cardiology — a field where treatment decisions can carry enormous consequences and where patient preferences about quality of life versus longevity are deeply personal — that gap is particularly striking.
The AHA statement lays out what shared decision-making actually requires in practice. First, patients need information that is honest and balanced — not a sales pitch for a particular procedure, but a clear accounting of risks, benefits, and reasonable alternatives. Second, clinical expertise has to be translated into terms that connect to the patient's actual life, not delivered as abstract statistics. Third, and perhaps most importantly, the patient's own sense of what matters — what they fear, what they hope for, what trade-offs they are and are not willing to make — has to be woven into the decision itself.
The statement also addresses why the ten-percent figure is so stubbornly low and what might move it. Among the proposed remedies: reimbursing clinicians for the time that genuine consultation requires, rather than incentivizing speed; building decision-support tools directly into electronic health records so they are available at the point of care; moving toward team-based care models that distribute the work of patient communication; and training clinicians in communication skills that are not only more collaborative but also sensitive to the cultural, racial, ethnic, and language backgrounds of individual patients. That last point matters because shared decision-making is not a one-size-fits-all script — it requires meeting patients where they are.
The statement was developed with input from across the AHA's organizational structure, drawing on councils covering nursing, clinical cardiology, hypertension, kidney disease, congenital heart conditions, lifestyle and metabolic health, peripheral vascular disease, epidemiology, and stroke. That breadth signals that the AHA sees this not as a niche concern but as a foundational issue for cardiovascular medicine as a whole.
Scientific statements of this kind are designed to map the current state of knowledge and point toward where more research is needed. They do not prescribe specific treatments. What this one prescribes, in effect, is a different kind of relationship between clinician and patient — one where the patient is a participant in their own care rather than a recipient of it. Whether the structural changes required to make that happen — reimbursement reform, technology integration, training overhauls — gain traction is the question worth watching.
Citas Notables
Shared decision-making requires clearly communicated, unbiased evidence about risks and benefits, clinical expertise relevant to the patient, and genuine inclusion of the patient's values and goals.— American Heart Association scientific statement, paraphrased
La Conversación del Hearth Otra perspectiva de la historia
Ten percent seems shockingly low. Is that number credible?
It comes from more than a hundred trials, so it's not a guess. It reflects how consultations actually unfold when researchers observe them — and the finding holds across multiple specialties, not just cardiology.
What does a consultation look like when shared decision-making isn't happening?
The clinician presents a recommended course of action, the patient nods or asks a few questions, and a decision gets made — but the patient's values and preferences were never really on the table. It's efficient, but it's not collaborative.
Why does it matter that the patient's values are included? Isn't the doctor's job to know what's medically best?
Medically best and personally best aren't always the same thing. In cardiology especially, patients often face real trade-offs — between longevity and quality of life, between aggressive treatment and its side effects. Those trade-offs can only be navigated by the person living the life.
So what's actually stopping this from happening more often?
Time and money, mostly. A genuine shared decision-making conversation takes longer, and the current reimbursement structure doesn't reward it. Clinicians aren't always trained for it either.
The statement mentions cultural and language sensitivity. Why flag that specifically?
Because shared decision-making isn't a neutral script. What counts as a meaningful conversation, how much information a patient wants, how decisions are made within families — all of that varies. A one-size approach can fail the people who most need to be heard.
What's the most practical fix the AHA is pointing toward?
Embedding decision aids directly into electronic health records stands out — it puts the tools at the point of care, where they're actually needed, rather than leaving it to individual clinicians to remember to use them.
Does this statement change anything on its own?
Not immediately. It maps the evidence and names the gaps. The harder work — reimbursement reform, training overhauls — happens elsewhere. But naming the problem clearly is where that work begins.