Radial Artery Versus Femoral Artery Access Options in Coronary Angiogram Procedures

Abstract

Background— Vascular access options in coronary angiography can be considered a preference-sensitive decision, where the benefits/risks have different levels of significance, depending on the individual patient. For preference-sensitive healthcare options, patient decision aids (PtDA) significantly improve the process of decision-making. The purpose of this trial was to evaluate the effectiveness of an evidence-based PtDA compared with usual care in patients eligible for radial and femoral artery access. Methods and Results— We conducted a single-center, nonblinded, randomized controlled trial with patients eligible for both femoral and radial access as per their treating physician. The PtDA was designed to guide patients to make an informed choice, consistent with their preferences and values. The primary outcome, decisional conflict, was assessed using the validated decisional conflict scale. One hundred fifty patients were randomized (vascular access PtDA=76 versus usual care=74). The intervention group had a significantly reduced decisional conflict scale compared with control (unadjusted 14.8 versus 19.5, P =0.04) and were significantly more knowledgeable regarding risks/benefits associated with each vascular access (mean knowledge score 3/5 (95% confidence interval, 2.6 to 3.3) versus 2/5 (95% confidence interval, 1.7 to 2.3, P <0.01). PtDA patients had better informed value congruence with their vascular access received (47.3% versus 25.7%, P <0.01). There were no significant differences in procedural success or safety between the 2 groups. Conclusions— A vascular access PtDA for eligible patients undergoing coronary angiogram procedures reduces decisional conflict and improves value congruence and the patients' knowledge of their healthcare options; however, a multicenter study, powered to confirm these benefits and evaluate differences in procedural success or complications, is required. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01032551.

Measuring patient-centered care: An updated systematic review of how studies define and report concordance between patients’ preferences and medical treatments

“…Twenty-six of the 61 studies involved a patient decision aid [16,18,20,22,25,32,33,[47][48][49][50][51][52][53]56,[58][59][60][61]64,66,68,[72][73][74][75]. Four additional studies reported using education materials such as educational sessions or pamphlets but did not refer to them as decision aids [17,43,63,70].…”

Shared Decision-Making and Patient Decision Aids

“…The study found that the decision aid resulted in a significant reduction in decisional conflict (unadjusted results), an increase in knowledge, and an increase in percentage of patients who made an informed, values-congruent choice. 6 There was no difference in the rates of procedures, nor in the success or safety of the procedures between the two groups, although the study was not powered to detect such differences.…”

“…Further, the decision aid arm had significantly fewer admissions to the observation unit (58% versus 77%) compared with the control group, and there was no difference in 30-day cardiac adverse events. 5 The second study, a randomized, controlled trial by Schwalm and colleagues, 6 evaluated a patient decision aid that focused on femoral versus radial artery access for coronary angiography. The decision aid was a 3-page booklet that patients reviewed immediately before the catheterization.…”

Shared Decision Making

“…Randomized, controlled trials of DAs for coronary artery disease treatment, statin use, anticoagulation for atrial fibrillation, heart failure self-management, vascular access for cardiac catheterization, acute low-risk chest pain, and coronary artery disease prevention have shown that use of such DAs improves the decision-making process by increasing knowledge, improving risk communication, decreasing decisional conflict, increasing participation in care, and increasing value congruence. [43][44][45][46][47][48] The effect of DAs on such outcomes as self-efficacy and medication adherence has not yet been definitively established.…”