Availability of patient decision aids for stroke prevention in atrial fibrillation: A systematic review

O’Neill, Elizabeth; Grande, Stuart W.; Sherman, Ariel; Elwyn, Glyn; Coylewright, Megan

doi:10.1016/j.ahj.2017.05.014

Cited by 39 publications

(39 citation statements)

References 40 publications

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“…To date, 3 clinical trials have tested the effect of using SDM tools to facilitate real-life decisions about anticoagulant treatment in patients with AF; those clinical trials yielded inconsistent results with regard to patient knowledge, decisional conflict, and anticoagulant treatment choices. 9 Compared with those studies, the present clinical trial combined the evaluation of an SDM tool that supported both patients and clinicians in deciding how to prevent strokes (including the option to receive DOAC medications), rather than supporting patients alone, with an assessment of the intervention’s effectiveness through the use of recorded encounters.…”

Section: Discussionmentioning

confidence: 99%

“… 8 To implement this recommendation, several tools to facilitate SDM among patients with AF have been developed. 9 , 10 , 11 , 12 , 13 However, most of these tools have not been rigorously evaluated, omit DOAC medications, present outdated data, do not directly support the patient-clinician conversation, or do not address practical considerations that are important to the success of ongoing safe anticoagulant treatment, such as leisure activities, diet, travel, and out-of-pocket costs. 9 , 11 , 14 , 15 , 16 …”

Section: Introductionmentioning

confidence: 99%

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Assessment of Shared Decision-making for Stroke Prevention in Patients With Atrial Fibrillation

et al. 2020

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; for the Shared Decision Making for Atrial Fibrillation (SDM4AFib) Trial Investigators IMPORTANCE Shared decision-making (SDM) about anticoagulant treatment in patients with atrial fibrillation (AF) is widely recommended but its effectiveness is unclear. OBJECTIVE To assess the extent to which the use of an SDM tool affects the quality of SDM and anticoagulant treatment decisions in at-risk patients with AF. DESIGN, SETTING, AND PARTICIPANTS This encounter-randomized trial recruited patients with nonvalvular AF who were considering starting or reviewing anticoagulant treatment and their clinicians at academic, community, and safety-net medical centers between January 30, 2017 and June 27, 2019. Encounters were randomized to either the standard care arm or care that included the use of an SDM tool (intervention arm). Data were analyzed from August 1 to November 30, 2019. INTERVENTIONS Standard care or care using the Anticoagulation Choice Shared Decision Making tool (which presents individualized risk estimates and compares anticoagulant treatment options across issues of importance to patients) during the clinical encounter. MAIN OUTCOMES AND MEASURES Quality of SDM (which included quality of communication, patient knowledge about AF and anticoagulant treatment, accuracy of patient estimates of their own stroke risk [within 30% of their estimate], decisional conflict, and satisfaction), decisions made during the encounter, duration of the encounter, and clinician involvement of patients in the SDM process. RESULTS The clinical trial enrolled 922 patients (559 men [60.6%]; mean [SD] age, 71 [11] years) and 244 clinicians. A total of 463 patients were randomized to the intervention arm and 459 patients to the standard care arm. Participants in both arms reported high communication quality, high knowledge, and low decisional conflict, demonstrated low accuracy in their risk perception, and would similarly recommend the approach used in their encounter. Clinicians were significantly more satisfied after intervention encounters (400 of 453 encounters [88.3%] vs 277 of 448 encounters [61.8%]; adjusted relative risk, 1.49; 95% CI, 1.42-1.53). A total of 747 of 873 patients (85.6%) chose to start or continue receiving an anticoagulant medication. Patient involvement in decision-making (as assessed through video recordings of the encounters using the Observing Patient Involvement in Decision Making 12-item scale) scores were significantly higher in the intervention arm (mean [SD] score, 33.0 [10.8] points vs 29.1 [13.1] points, respectively; adjusted mean difference, 4.2 points; 95% CI, 2.8-5.6 points). No significant between-arm difference was found in encounter duration (mean [SD] duration, 32 [16] minutes in the intervention arm vs 31 [17] minutes in the standard care arm; adjusted mean between-arm difference, 1.1; 95% CI, −0.3 to 2.5 minutes). CONCLUSION AND RELEVANCE The use of an SDM encounter tool improved several measures of SDM quality and clinician satisfaction, with no significant effect on treatment decisions...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of Shared Decision-making for Stroke Prevention in Patients With Atrial Fibrillation

et al. 2020

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“…11 Across a wide spectrum of individual risk, anticoagulation effectively reduces the risk of stroke on average by approximately 65%. 12 Several tools to facilitate SDM in AF have been developed, 7,13,14 but most have not been rigorously evaluated, omit newer anticoagulation options, or present outdated data. 13 In addition, most fail to directly support the discussion of practical ways in which anticoagulation affects matters important to patients, such as leisure activities, diet, travel, and out-of-pocket costs.…”

Section: Anticoagulation For Stroke Prevention In Af: a Call For Sdmmentioning

confidence: 99%

“…12 Several tools to facilitate SDM in AF have been developed, 7,13,14 but most have not been rigorously evaluated, omit newer anticoagulation options, or present outdated data. 13 In addition, most fail to directly support the discussion of practical ways in which anticoagulation affects matters important to patients, such as leisure activities, diet, travel, and out-of-pocket costs. [14][15][16][17] To address these limitations and support SDM conversations between clinicians and their at-risk patients with AF considering anticoagulation therapy, we developed a new conversation aid, Anticoagulation Choice.…”

Section: Anticoagulation For Stroke Prevention In Af: a Call For Sdmmentioning

confidence: 99%

Developing a Conversation Aid to Support Shared Decision Making: Reflections on Designing Anticoagulation Choice

Noseworthy

Branda

Kunneman

et al. 2019

Mayo Clinic Proceedings

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Patient-centered care requires that treatments respond to the problematic situation of each patient in a manner that makes intellectual, emotional, and practical sense, an achievement that requires shared decision making (SDM). To implement SDM in practice, toolsdsometimes called conversation aids or decision aidsdare prepared by collating, curating, and presenting high-quality, comprehensive, and up-to-date evidence. Yet, the literature offers limited guidance for how to make evidence support SDM. Herein, we describe our approach and the challenges encountered during the development of Anticoagulation Choice, a conversation aid to help patients with atrial fibrillation and their clinicians jointly consider the risk of thromboembolic stroke and decide whether and how to respond to this risk with anticoagulation.

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“…Atrial fibrillation (AF) is a common irregular cardiac rhythm disorder [ 1 ], which has been proven to exacerbate the risk for several cardiac and cerebral vascular diseases, especially strokes [ 2 , 3 ]. A recent report further indicated that about 15% of stroke events in the United States are attributable to AF [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Reduced Stroke Risk among Patients with Atrial Fibrillation Receiving Chinese Herbal Medicines Treatment: Analysis of Domestic Data in Taiwan

et al. 2020

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Background and objectives: Patients with atrial fibrillation (AF) reportedly have a much higher risk of death due to stroke. Faced with this heavy burden, it remains unclear if the Chinese herbal medicines (CHMs), the most common form complementary and alternative medicine, can lower the risk of stroke for them. This study aimed to evaluate the association of CHMs use with stroke risk among them. Materials and Methods: From a nationwide database, 11,456 AF patients aged ≧ 20 years between 1998 and 2007 were identified. Afterwards, we enrolled 2670 CHMs users and randomly selected 2670 non-CHMs users using the propensity score method. The occurrence of stroke was recorded until the end of 2012. Results: Within the follow-up period, 671 CHMs users and 900 non-CHMs users developed stroke, with incidence rates of 33.02 and 45.46 per 1000 person-years, respectively. CHMs use was associated with a 30% lower stroke risk, especially for those receiving CHMs for over two years. Conclusions: The findings of the present study suggest that adding CHMs to conventional therapy could decrease subsequent stroke risk for AF patients. It is also suggested that prospective randomized trials are needed to further clarify if the detected association revealed in this study supports a causal link, and to identify the specific CHMs that may be beneficial to AF patients.

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Availability of patient decision aids for stroke prevention in atrial fibrillation: A systematic review

Cited by 39 publications

References 40 publications

Assessment of Shared Decision-making for Stroke Prevention in Patients With Atrial Fibrillation

Assessment of Shared Decision-making for Stroke Prevention in Patients With Atrial Fibrillation

Developing a Conversation Aid to Support Shared Decision Making: Reflections on Designing Anticoagulation Choice

Reduced Stroke Risk among Patients with Atrial Fibrillation Receiving Chinese Herbal Medicines Treatment: Analysis of Domestic Data in Taiwan

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