Although this principle, in the setting of cardiovascular disease, has received only limited study, the concept of shared decision making increasingly is viewed as an approach that ensures that patients remain involved in key decisions. This approach leads to higher quality of care.44,45 To ensure that the patient is able to make the most informed decisions possible, the provider must give sufficient information about the underlying disease process, along with all relevant diagnostic and therapeutic options including anticipated outcomes, risks, and costs to the patient.46 This information should be provided in a manner that is readily comprehensible and permits the opportunity for dialog and questions. Patients should be encouraged to seek additional informa- tion from other sources, including those on the Internet, such as those maintained by the National Institutes of Health, the Centers for Disease Control and Prevention, and the ACCF/ AHA. Substantial research indicates that when informed about absolute or marginal benefit, patients often elect to postpone or forego invasive procedures. Two patients with similar pretest probabilities of IHD could prefer different approaches because of variations in personal beliefs, eco- nomic situation, or stage of life. Because of the variation in symptoms and clinical characteristics among patients, as well as their unique perceptions, expectations, and preferences, there is often no single correct approach to any given set of clinical circumstances. In assisting patients to reach an Table 4. Estimated Direct and Indirect Costs (in Billions of Dollars) of Heart Disease and Coronary Heart Disease: United Heart Disease ($ in Billions) Coronary Heart Disease ($ in Billions) Direct costs Drugs/other Home health care 8.3 2.5 Indirect costs All estimates prepared by Thomas Thom, National Heart, Lung, and Blood Institute. *Lost future earnings of persons who will die in 2010, discounted at 3%. Reproduced from Lloyd-Jones et al.27 Figure 2. 