Evaluating the Effect of a Patient Decision Aid for Atrial Fibrillation Stroke Prevention Therapy

Loewen, Peter; Bansback, Nick; Andrade, Jason G.; Kwan, Leanne; Lynd, Larry D.; McClean, Alison R; MacGillivray, Jenny; Salmasi, Shahrzad

doi:10.1177/1060028019828420

Cited by 12 publications

(44 citation statements)

References 26 publications

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“…Table 1 and Supplementary Material 5 describe the 14 included SDM tools. 31 – 55 All but 2 were in English; the mAF app 42 was in Chinese and MATCh AFib 43 , 44 in Portuguese. When examining their intended use, 3 were patient decision aids, 5 were encounter tools, 4 had features of both, and 2 were not classifiable because of either lack of information or access to the tool itself.…”

Section: Resultsmentioning

confidence: 99%

“…Six studies, including 2 randomized trials 42 , 48 and 4 nonrandomized studies, 34 , 43 , 53 , 55 at high risk of bias reported the effect of SDM tools on SDM outcomes ( Table 2 and Supplementary Material 6 ).…”

Section: Resultsmentioning

confidence: 99%

“…Twelve decision aids met more than 50% of the IPDAS items (Figure 2). The top-rated tools were PtDA, [51][52][53] Anticoagulation Choice, [45][46][47][48] Don't Wait to Anticoagulate, 38 and PDA, 55 which met .70% of all IPDAS items. PtDA was the only tool that assessed for readability.…”

Section: Sdm Tool Quality Assessmentmentioning

confidence: 99%

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Shared Decision Making Tools for People Facing Stroke Prevention Strategies in Atrial Fibrillation: A Systematic Review and Environmental Scan

et al. 2021

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Objective Shared decision making (SDM) tools can help implement guideline recommendations for patients with atrial fibrillation (AF) considering stroke prevention strategies. We sought to characterize all available SDM tools for this purpose and examine their quality and clinical impact. Methods We searched through multiple bibliographic databases, social media, and an SDM tool repository from inception to May 2020 and contacted authors of identified SDM tools. Eligible tools had to offer information about warfarin and ≥1 direct oral anticoagulant. We extracted tool characteristics, assessed their adherence to the International Patient Decision Aids Standards, and obtained information about their efficacy in promoting SDM. Results We found 14 SDM tools. Most tools provided up-to-date information about the options, but very few included practical considerations (e.g., out-of-pocket cost). Five of these SDM tools, all used by patients prior to the encounter, were tested in trials at high risk of bias and were found to produce small improvements in patient knowledge and reductions in decisional conflict. Conclusion Several SDM tools for stroke prevention in AF are available, but whether they promote high-quality SDM is yet to be known. The implementation of guidelines for SDM in this context requires user-centered development and evaluation of SDM tools that can effectively promote high-quality SDM and improve stroke prevention in patients with AF.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Shared Decision Making Tools for People Facing Stroke Prevention Strategies in Atrial Fibrillation: A Systematic Review and Environmental Scan

et al. 2021

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“…There is currently no evidence that directly addresses the role of shared decision-making in the context of ASA for primary prevention, although interventions to support shared decisionmaking have been evaluated for the treatment of hypertension, 25,26 atrial fibrillation 27 and diabetes. 28…”

Section: Shared Decision-makingmentioning

confidence: 99%

Canadian Stroke Best Practice Recommendations, seventh edition: acetylsalicylic acid for prevention of vascular events

Wein

Lindsay

Gladstone

et al. 2020

CMAJ

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I n 2016, 270 204 people in Canada (excluding Quebec) were admitted to hospital for heart conditions, stroke and vascular cognitive impairment, including 107 391 women and 162 813 men, of whom 91 524 died. 1 This equates to 1 out of every 3 deaths in Canada and outpaces other diseases; 13% more people die of heart conditions, stroke or vascular cognitive impairment than die from all cancers combined. 1 The benefits of acetylsalicylic acid (ASA) for secondary prevention of atherosclerotic cardiovascular disease are well established. In contrast, although low-dose ASA therapy for primary prevention of atherosclerotic cardiovascular disease was once commonly recommended, this practice is now being reconsidered in light of recent evidence. Three large randomized controlled trials on primary prevention found no net benefit of ASA for prevention of cardiovascular events or mortality in healthy older adults (defined in the ASPREE [Aspirin in Reducing Events in the Elderly] trial as > 65 yr) or persons with diabetes or other risk factors. 2-4 Moreover, 2 recent systematic reviews incorporating the evidence from these trials provided somewhat conflicting results. 5,6 Both found that the risk of major bleeding events was significantly increased in participants receiving ASA. However, 1 systematic review found that the use of ASA did not reduce the risk of all-cause mortality or ischemic stroke, 6 while the other reported that ASA did reduce the risk of a composite of cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke and ischemic stroke. 5 With greater awareness of the risks and benefits of ASA, overall lower rates of cardiovascular events in contemporary populations compared with those in older studies, and conflicting recommendations in guidelines and systematic reviews, clinicians are increasingly uncertain about the role of ASA for primary prevention. 2 The actual number of people in Canada who are taking ASA prophylactically (either as prescribed by a health professional or of their own volition) is not known, although it is likely substantial. A US study reported results from a public poll that found 29 million people were taking ASA in that country, with 23% doing so without a physician's recommendation. 7

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“…On ne dispose actuellement d'aucune donnée probante quant au rôle de la prise de décision partagée dans le contexte d'un traitement avec l'AAS en prévention primaire, quoique des interventions visant à appuyer la prise de décision partagée ont été évaluées pour le traitement de l'hypertension artérielle 25,26 , de la fibrillation auriculaire 27 et du diabète 28 .…”

Section: Prise De Décision Partagéeunclassified

Recommandations canadiennes pour les pratiques optimales de soins de l’AVC, septième édition : l’acide acétylsalicylique pour la prévention d’événements vasculaires

Wein

Lindsay

Gladstone

et al. 2020

CMAJ

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Evaluating the Effect of a Patient Decision Aid for Atrial Fibrillation Stroke Prevention Therapy

Cited by 12 publications

References 26 publications

Shared Decision Making Tools for People Facing Stroke Prevention Strategies in Atrial Fibrillation: A Systematic Review and Environmental Scan

Shared Decision Making Tools for People Facing Stroke Prevention Strategies in Atrial Fibrillation: A Systematic Review and Environmental Scan

Canadian Stroke Best Practice Recommendations, seventh edition: acetylsalicylic acid for prevention of vascular events

Recommandations canadiennes pour les pratiques optimales de soins de l’AVC, septième édition : l’acide acétylsalicylique pour la prévention d’événements vasculaires

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