Impact of a patient decision aid on care among patients with nonvalvular atrial fibrillation: a cluster randomized trial

McAlister, Finlay A.; Man-Son-Hing, Malcolm; Straus, Sharon E.; Ghali, William A.; Anderson, David R.; Majumdar, Sumit R.; Gibson, Paul; Cox, Jafna L.; Fradette, Miriam

doi:10.1503/cmaj.050091

Cited by 86 publications

(132 citation statements)

References 24 publications

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“…Regardless, our results suggest that faxed evidence reminders to primary care physicians are insufficient on their own to optimize the quality of care for patients with chronic coronary artery disease in the outpatient setting. Some form of stimulus in addition to point-of-care reminders (e.g., patient activation, 28,29 involvement of allied health professionals 34 ) appears to be needed to optimize the care, and hence outcomes, for patients. This article has been peer reviewed.…”

Section: Resultsmentioning

confidence: 99%

The Enhancing Secondary Prevention in Coronary Artery Disease trial

McAlister¹,

Fradette²,

Majumdar³

et al. 2009

Canadian Medical Association Journal

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Background: Proven efficacious therapies are sometimes underused in patients with chronic cardiac conditions, resulting in suboptimal outcomes. We evaluated whether evidence summaries, which were either unsigned or signed by local opinion leaders, improved the quality of secondary prevention care delivered by primary care physicians of patients with coronary artery disease. Methods:We performed a randomized trial, clustered at the level of the primary care physician, with 3 study arms: control, unsigned statements or opinion leader statements. The statements were faxed to primary care physicians of adults with coronary artery disease at the time of elective cardiac catheterization. The primary outcome was improvement in statin management (initiation or dose increase) 6 months after catheterization. Results:We enrolled 480 adults from 252 practices. Although statin use was high at baseline (n = 316 [66%]), most patients were taking a low dose (mean 32% of the guideline-recommended dose), and their low-density lipoprotein (LDL) cholesterol levels were elevated (mean 3.09 mmol/L). Six months after catheterization, statin management had improved in 79 of 157 patients (50%) in the control arm, 85 of 158 (54%) patients in the unsigned statement group (adjusted odds ratio [OR] 1.18, 95% CI 0.71-1.94, p = 0.52) and 99 of 165 (60%) patients in the opinion leader statement group (adjusted OR 1.51, 95% CI 0.94-2.42, p = 0.09). The mean fasting LDL cholesterol levels after 6 months were similar in all 3 study arms: 2.35 (standard deviation [SD] 0.86) mmol/L in the control arm compared with 2.24 (SD 0.73) among those in the opinion leader group (p = 0.48) and 2.19 (SD 0.68) in the unsigned statement group (p = 0.32).Interpretation: Faxed evidence reminders for primary care physicians, even when endorsed by local opinion leaders, were insufficient to optimize the quality of care for adults with coronary artery disease. ClinicalTrials.gov trial register no. NCT00175240. AbstractPreviously published at www.cmaj.ca

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Section: Resultsmentioning

confidence: 99%

The Enhancing Secondary Prevention in Coronary Artery Disease trial

McAlister¹,

Fradette²,

Majumdar³

et al. 2009

Canadian Medical Association Journal

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“…Interestingly, compared with admission to the other departments, patients admitted to the neurology department were more likely to be prescribed NOACs than prescribed warfarin. Possibly, neurologists have a different approach to selecting an antithrombotic therapy that is more aligned with international guidelines [27].…”

Section: Discussionmentioning

confidence: 99%

Pilot of a Computerised Antithrombotic Risk Assessment Tool Version 2 (CARATV2.0) for stroke prevention in atrial fibrillation

Wang

Bajorek

2017

Cardiol J.

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“…[51][52][53][54][55][56][57][58][59] Participants in studies were adults (55-75 years old) with AF; there was homogeneity of the study populations with respect to patients' level of education and health literacy. One study used a different type of TPE mechanism than the other 8 studies, by implementing a chronic care model for nurse-led care in a cardiology clinic that incorporated TPE to provide patient education on AF and medication use, as well as an integrated self-management intervention for AF patients using telecare (eg, weight monitoring, heart rhythm monitoring) and ongoing follow-up over time for patients with AF.…”

Section: Atrial Fibrillationmentioning

confidence: 99%

Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association

Barnason¹,

White‐Williams²,

Rossi³

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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A lthough the overall rate of death associated with cardiovascular disease (CVD) continues to decline in the United States, [1][2][3] CVD is a leading cause of mortality and disability. The burden of CVD remains high, underscoring the need to improve long-term management of CVD as a chronic illness. Effective implementation of current treatment guidelines for primary and secondary prevention of CVD relies heavily on patient knowledge and engagement in carrying out the plan of care. Healthcare reforms have increasingly shifted the responsibility for self-management to patients and families as hospital stays and ambulatory visits have become shorter and less frequent.Background-The burden of cardiovascular disease as a chronic illness increasingly requires patients to assume more responsibility for their self-management. Patient education is believed to be an essential component of cardiovascular care; however, there is limited evidence about specific therapeutic patient education approaches used and the impact on patient self-management outcomes. Methods and Results-An integrative review of the literature was conducted to critically analyze published research studies of therapeutic patient education for self-management in selected cardiovascular conditions. There was variability in methodological approaches across settings and disease conditions. The most effective interventions were tailored to individual patient needs, used multiple components to improve self-management outcomes, and often used multidisciplinary approaches. Conclusions-This synthesis of evidence expands the base of knowledge related to the development of patient selfmanagement skills and provides direction for more rigorous research. Recommendations are provided to guide the implementation of therapeutic patient education in clinical practice and the design of comprehensive self-management interventions to improve outcomes for cardiovascular patients. (Circ Cardiovasc Qual Outcomes. 2017;10:e000025.

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Impact of a patient decision aid on care among patients with nonvalvular atrial fibrillation: a cluster randomized trial

Cited by 86 publications

References 24 publications

The Enhancing Secondary Prevention in Coronary Artery Disease trial

The Enhancing Secondary Prevention in Coronary Artery Disease trial

Pilot of a Computerised Antithrombotic Risk Assessment Tool Version 2 (CARATV2.0) for stroke prevention in atrial fibrillation

Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association

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