Shared Decision-Making and Cardiovascular Health: A Scientific Statement From the American Heart Association

Abstract

Shared decision-making is increasingly embraced in health care and recommended in cardiovascular guidelines. Patient involvement in health care decisions, patient-clinician communication, and models of patient-centered care are critical to improve health outcomes and to promote equity, but formal models and evaluation in cardiovascular care are nascent. Shared decision-making promotes equity by involving clinicians and patients, sharing the best available evidence, and recognizing the needs, values, and experiences of individuals and their families when faced with the task of making decisions. Broad endorsement of shared decision-making as a critical component of high-quality, value-based care has raised our awareness, although uptake in clinical practice remains suboptimal for a range of patient, clinician, and system issues. Strategies effective in promoting shared decision-making include educating clinicians on communication techniques, engaging multidisciplinary medical teams, incorporating trained decision coaches, and using tools (ie, patient decision aids) at appropriate literacy and numeracy levels to support patients in their cardiovascular decisions. This scientific statement shines a light on the limited but growing body of evidence of the impact of shared decision-making on cardiovascular outcomes and the potential of shared decision-making as a driver of health equity so that everyone has just opportunities. Multilevel solutions must align to address challenges in policies and reimbursement, system-level leadership and infrastructure, clinician training, access to decision aids, and patient engagement to fully support patients and clinicians to engage in the shared decision-making process and to drive equity and improvement in cardiovascular outcomes.

Shared Decision-Making in Cardiovascular Risk Factor Management

“…Studies were included in this review if they met the following criteria: (1) the population included adults (aged Ն18 years) with cardiovascular risk factors (diabetes, hypertension, dyslipidemia, overweight and obesity, and tobacco use); (2) an SDM-based intervention type was used; (3) outcomes examined included decisional outcomes (decisional conflict, decisional quality, or SDM scores), cardiovascular risk factor outcomes (HbA 1c , SBP levels, low-density lipoprotein, total cholesterol, smoking cessation, or CVD risk), and health behavioral outcomes (physical activity, healthy diet, or medication management); and (4) a randomized clinical trial (RCT) study design was used. In our systematic review, we identified interventions as SDM based if they met the following criteria based on the published scientific statement 5 : clinicians and patients made decisions together, the best available evidence was used, and decisions were based on patients' informed values or preferences.…”

“…4 This approach enables patients, in concert with their clinicians, to make informed decisions about their health care that incorporate their goals, values, and preferences. 5 Previous systematic reviews showed that the implementation of SDM in primary care may be effective in reducing decisional conflict and improving knowledge of diseases and treatment options, awareness of risk, and satisfaction with the decisions made. [6][7][8][9] The incorporation of SDM in cardiovascular risk prevention and management has the potential to increase patient engagement in lifestyle changes, medication adherence, and glycemic and blood pressure control and lead to improved health outcomes.…”

“…[6][7][8][9] The incorporation of SDM in cardiovascular risk prevention and management has the potential to increase patient engagement in lifestyle changes, medication adherence, and glycemic and blood pressure control and lead to improved health outcomes. 5 Shared decision-making may promote equity by involving clinicians and patients, sharing the best available evidence, and recognizing the needs, values, and experiences of individuals and their families when faced with the task of making decisions. 5 Although SDM is increasingly embraced in health care and recommended in cardiovascular guidelines, 1,2 the extent to which SDM is used in research assessing interventions for managing cardiovascular risk factors remains unclear.…”

“…5 Shared decision-making may promote equity by involving clinicians and patients, sharing the best available evidence, and recognizing the needs, values, and experiences of individuals and their families when faced with the task of making decisions. 5 Although SDM is increasingly embraced in health care and recommended in cardiovascular guidelines, 1,2 the extent to which SDM is used in research assessing interventions for managing cardiovascular risk factors remains unclear. In addition, the effect of SDM-based interventions that focus on managing cardiovascular risk factors on decisional outcomes, cardiovascular risk factors, and health behaviors remains uncertain.…”

Can the HEARTS initiative reduce the burden of cardiovascular disease?

“…Another important aspect is considering patient autonomy and developing shared decision-making approaches to increase patient participation in their care, hence making the programme more effective. Interventions exist, such as educating the healthcare team on communication techniques; engaging multidisciplinary approaches, including decision coaches; and using patient decision aids, appropriate for the literacy and numeracy levels of the patient populations 12. Different preferences for treatment might require a careful balancing of patient preferences and best effectiveness aimed with the HEARTS approach, for example, when considering stepwise treatments to reach hypertension control.…”