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

Roldan, Victor D Torres; McCarthy, Sarah; Ponce, Oscar J.; Belluzzo, Tereza; Urtecho, Meritxell; Suárez, Nataly R. Espinoza; Toloza, Freddy J.K.; Thota, Anjali; Organick, Paige; Barrera, Francisco J.; Liu-Sanchez, Carolina; Jaladi, Soumya; Prokop, Larry J.; Ozanne, Elissa M.; Fagerlin, Angela; Hargraves, Ian; Noseworthy, Peter A.; Montori, Víctor M.; Brito, Juan P.

doi:10.1177/0272989x211005655

Cited by 25 publications

(26 citation statements)

References 45 publications

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“…The results align with published studies of SDM for stroke prevention in AF, some of which have been shown to produce small improvements in patient knowledge and reductions in decisional con ict [15][16][17] .…”

Section: Discussionsupporting

confidence: 85%

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Impact of shared decision-making in patients with atrial fibrillation eligible for novel oral anticoagulant therapy

Chen

Yang

et al. 2022

Preprint

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Shared decision-making (SDM) promotes greater patient awareness about medical conditions and treatments, and facilitates patient involvement in care decisions. This two-stage multicenter study evaluated the impact of SDM in Taiwanese adults with atrial fibrillation (AF) eligible for novel oral anticoagulant (NOAC) therapy. Participants were NOAC-naïve (case) or dabigatran-experienced (control). During Stage I, case participants (n = 124) completed a semi-structured survey before and after viewing SDM materials on stroke prevention for AF. The surveys collected data on anxiety about AF, confidence in healthcare professionals, usefulness of SDM materials, and perception of different NOACs. During Stage II, both case participants (n = 87) and control participants (n = 104) completed another survey. Fewer case participants were anxious about AF (p < 0.01), and more had confidence in healthcare professionals (p < 0.01) after viewing the SDM materials than before. Most case participants (≥ 90%) rated the SDM materials “very helpful”. Dabigatran was the NOAC of choice after viewing the SDM materials among 90% of case participants. In Stage II, participants viewing SDM before initiating dabigatran had lower anxiety (case, 43%; control, 53%; p < 0.01) and a higher level of trust (case, 92%; control, 84%; p < 0.01). In conclusion, SDM reduced anxiety and improved trust in healthcare professionals among NOAC-naïve participants with AF.

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Section: Discussionsupporting

confidence: 85%

“…Tools for SDM should be feasible to implement in busy clinical practices 15 . In the current study, the SDM materials, which comprised a short presentation on AF and its diagnosis and treatment, were introduced in three tertiary medical centers in Taiwan.…”

Section: Discussionmentioning

confidence: 99%

Impact of shared decision-making in patients with atrial fibrillation eligible for novel oral anticoagulant therapy

Chen

Yang

et al. 2022

Preprint

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“…One review [44] met 15 of 16 AMSTAR2 domains, one [48] fully or partly met 14, and one [54] fully or partly met 13. Five reviews met just under half of their relevant criteria [51,57,58,61,62], and five reviews met just over half of their relevant criteria [47,50,60,63,64]. The remaining reviews met most of their relevant criteria.…”

Section: Self-monitoringmentioning

confidence: 99%

“…Interventions to improve adherence included the following: education and/or decision aids (four reviews) [44,55,62,64]; self-testing with clinician dosing or self-management with dosing according to rules (eight reviews) [38,44,46,48,53,54,61,63]; and pharmacist management (four reviews) [45,47,49,66]. The most common outcomes reported were TTR, proportion of INR measurements in range, or PDC (a measure used for direct OACs as they do not require as frequent blood monitoring as warfarin).…”

Section: Self-monitoringmentioning

confidence: 99%

Oral anticoagulants: a systematic overview of reviews on efficacy and safety, genotyping, self-monitoring, and stakeholder experiences

Khouja

Brunton²,

Richardson³

et al. 2022

Syst Rev

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Background This systematic overview was commissioned by England’s Department of Health and Social Care (DHSC) to assess the evidence on direct (previously ‘novel’) oral anticoagulants (OACs), compared with usual care, in adults, to prevent stroke related to atrial fibrillation (AF), and to prevent and treat venous thromboembolism (VTE). Specifically, to assess efficacy and safety, genotyping, self-monitoring, and patient and clinician experiences of OACs. Methods We searched MEDLINE, Embase, ASSIA, and CINAHL, in October, 2017, updated in November 2021. We included systematic reviews, published from 2014, in English, assessing OACs, in adults. We rated review quality using AMSTAR2 or the JBI checklist. Two reviewers extracted and synthesised the main findings from the included reviews. Results We included 49 systematic reviews; one evaluated efficacy, safety, and cost-effectiveness, 17 assessed genotyping, 23 self-monitoring or adherence, and 15 experiences (seven assessed two topics). Generally, the direct OACs, particularly apixaban (5 mg twice daily), were more effective and safer than warfarin in preventing AF-related stroke. For VTE, there was little evidence of differences in efficacy between direct OACs and low-molecular-weight heparin (prevention), warfarin (treatment), and warfarin or aspirin (secondary prevention). The evidence suggested that some direct OACs may reduce the risk of bleeding, compared with warfarin. One review of genotype-guided warfarin dosing assessed AF patients; no significant differences in stroke prevention were reported. Education about OACs, in patients with AF, could improve adherence. Pharmacist management of coagulation may be better than primary care management. Patients were more adherent to direct OACs than warfarin. Drug efficacy was highly valued by patients and most clinicians, followed by safety. No other factors consistently affected patients’ choice of anticoagulant and adherence to treatment. Patients were more satisfied with direct OACs than warfarin. Conclusions For stroke prevention in AF, direct OACs seem to be more effective and safer than usual care, and apixaban (5 mg twice daily) had the best profile. For VTE, there was no strong evidence that direct OACs were better than usual care. Education and pharmacist management could improve coagulation control. Both clinicians and patients rated efficacy and safety as the most important factors in managing AF and VTE. Systematic review registration PROSPERO CRD42017084263—one deviation; efficacy and safety were from one review.

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“…However, although DOACs have been used widely since, there may still be an unmet barrier in clinical practice today with consequences for patient centred care (17).…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Use of direct oral anticoagulants in primary care: a qualitative study integrating patient and practitioner perspectives

2022

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BackgroundElderly patients with atrial fibrillation (AF) are increasingly offered direct oral anticoagulants (DOACs) to reduce the risk of catastrophic stroke but still require clinical follow-up and compliance check to maintain patient safety. Although a recent qualitative meta-analysis has explored up to date research in this area,1 little is known qualitatively, in the United Kingdom, about clinicians’ or patients’ views and experiences of DOAC use in primary care.AimTo understand the experiences of healthcare practitioners and patients in relation to DOAC use in primary care.Design & settingSemi-structured interviews were undertaken. Sixteen elderly AF patients taking DOACs, ten pharmacists and six general practitioners (GPs) were interviewed in Sheffield in 2018.MethodInterview questions were developed from a systematic literature review. Interviews were audio-recorded, transcribed, and analysed using six stage thematic analysis.ResultsThe integrated perspectives show that all three participant groups preferred DOACs over warfarin- driven mainly by the safety profile compared to warfarin. GPs valued pharmacists input in anticoagulant care and pharmacists discussed patient safety in the context of anticoagulant audits and highlighted the need for continuous patient education and counselling. Medication reviews by pharmacists was seen as a positive contribution to medicines optimisation.ConclusionPatients had an overriding trust in their doctors. GPs valued a collaborative approach with other clinicians and community pharmacists appeared to highlight operational challenges in primary care which may limit the effectiveness of interventions.

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

Cited by 25 publications

References 45 publications

Impact of shared decision-making in patients with atrial fibrillation eligible for novel oral anticoagulant therapy

Impact of shared decision-making in patients with atrial fibrillation eligible for novel oral anticoagulant therapy

Oral anticoagulants: a systematic overview of reviews on efficacy and safety, genotyping, self-monitoring, and stakeholder experiences

Use of direct oral anticoagulants in primary care: a qualitative study integrating patient and practitioner perspectives

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