Physicians are professionally obligated to provide accurate estimates of the risks, benefits, and costs of various therapeutic options that are based on the best available scientific data. Other factors can induce phy- sicians to recommend revascularization. These include med- icolegal concerns (often exaggerated) and feeling compelled to satisfy the expectations of patients and referring physicians (which are sometimes misinformed or unrealistic).426 Addi- tionally, there are well-documented regional variations in the use and appropriateness of cardiac procedures that appear to reflect local practice styles.427 This might partly reflect a mistaken belief by some physicians that more care is better care. 428 Although successful procedures can be psychologically satisfying to the physician and the patient, this does not justify the attendant economic costs and risk of complications of procedures that offer minimal, if any, genuine benefit.429 431 Although rarely discussed explicitly, financial incentives seem to affect the willingness of a minority of physicians and institutions to recommend certain procedures or drug thera- pies. Strong incentives created by the payment system en- courage overutilization. Also, a small number of physicians might have financial relationships with the manufacturers of devices or drugs that might represent apparent conflicts that ought to be disclosed to patients. At a higher level, those responsible for the payment system, the manufacturers of devices and drugs, and physicians making clinical decisions must commit to supporting guideline-based interventions. Any and all conflicts of interest must be revealed to patients in the process of informed consent before any invasive or noninvasive procedure. 4.2.2. Assessing Patients Quality of Life In addition to interventions undertaken to improve survival and prevent cardiovascular complications, therapy also is prescribed to improve patients health status, a general term that incorporates many facets, including severity of symp- toms, functional limitations, and quality of life. 