Influence of decision aids on patient preferences for anticoagulant therapy: a randomized trial

Abstract

Research W arfarin therapy is strongly recommended for the prevention of stroke in moderate-and high-risk patients with atrial fibrillation.1-10 However, it is associated with a risk of major bleeding. The actual rate of serious bleeding in clinical practice varies widely and depends on the patient's risk category and the quality of monitoring of the international normalized ratio.11-14 Studies in clinical settings have shown that warfarin's effectiveness is similar to that measured in randomized trials, but its utilization in clinical practice is lower than expected. 15-25Acetylsalicylic acid is safer than warfarin, but less effective.

Preferences for Oral Anticoagulants in Atrial Fibrillation: a Best–Best Discrete Choice Experiment

“…This is considered reasonable given (i) newly-diagnosed patients, like the general public, would not be aware of personal risk profiles before diagnosis, and (ii) the prevalence of AF increases with age (from approximately 40 to 50 years) [44,45]. This approach is consistent with those used in previous studies [32,33,[46][47][48], and such participants are also called ''patients at risk'' [34]. Recruitment was via a database of general public research participants maintained at the Centre for Health Economics and via advertising in the Monash University staff newsletter.…”

Implementation of Shared Decision Making in Cardiovascular Care

“…With acute conditions, such as new-onset chest pain that occurs unexpectedly and often prompts urgent medical evaluation, patients and caregivers typically do not have sufficient time to review their treatment options before the visit, necessitating use of an in-visit approach to SDM. 9 That being said, there are several cardiovascular conditions in which there is sufficient time for patients to learn about their diagnosis and consider the available treatment options, such as whether to undergo coronary angiography in patients with stable angina, 7 choice of anticoagulation therapy in patients with atrial fibrillation, 10 or treatment choice for severe aortic stenosis. 11 Nearly, all the published studies of out-of-visit decision aids have used a referral model of implementation in which patients were either sent the decision aid by mail or directed to use the decision aid at home by a healthcare professional.…”

Shared Decision Making in Atrial Fibrillation

“…49,51 More recent SDM studies in AF have reported decreased decisional conflict (the state of uncertainty surrounding a decision, a more accurate measure of the quality of the decision-making process because regret is strongly affected by the outcome the patient experiences, not the communication of the visit), increased patient satisfaction, and a trend toward increased knowledge compared with "traditional counseling" or guideline-based therapies groups, yet the findings have not been consistent. [52][53][54][55][56] Table 3 summarizes the evidence from these studies. 49,[52][53][54][55][56] However, it is critical to note that with the advent of the novel anticoagulants mentioned above since these studies, the number of options for stroke prevention has more than doubled, making this a far more complex decision.…”

“…[52][53][54][55][56] Table 3 summarizes the evidence from these studies. 49,[52][53][54][55][56] However, it is critical to note that with the advent of the novel anticoagulants mentioned above since these studies, the number of options for stroke prevention has more than doubled, making this a far more complex decision.…”