Shared decision-making tool reduces decision conflict and patient regret in use of anticoagulants for AF, study finds

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A recent presentation by Paul J Wang (Stanford School of Medicine, Stanford, USA) at the American Heart Association (AHA) Scientific Session 2022 conference (5-7 November, Chicago, USA) outlined the results of the ENHANCE-AF study into a new shared decision-making tool’s utility for helping atrial fibrillation (AF) patients make medically informed decisions. Oral anticoagulation (OAC) reduces AF patients’ likelihood of experiencing a stroke, but is often declined by patients due to their fears around increased bleeding.

The ENHANCE-AF study’s novel shared decision-making tool aimed to facilitate joint decision-making with clinicians and reduce decisional conflict. Wang identified the “primary problem” with stroke prevention in AF patients today as the fact that existing practices result in “a lack of patient satisfaction, therapy mismatched with patient preferences, wasted healthcare resources, and preventable adverse outcomes.”

The shared decision-making tool was made available on a smartphone, PC or tablet in English or Spanish. It includes videos comparing the risks of AF-induced stroke with the risks of anticoagulant-induced bleeding, a Q&A session, and a worksheet filled out by patients before they meet with their clinician.

To test the tool’s efficacy, the study’s authors enrolled 1,001 patients at five different sites, 495 of whom used the tool before consulting with their doctor, while 506 did not. The primary endpoint was the Decision Conflict Scale (DCS) at one month, which saw a seven-point reduction in median scores in the shared decision-making tool group. Speaking to Renal Interventions, Wang said, “in contrast to prior studies, ours achieved its primary endpoint.  The tool’s efficacy may be increased because of its being designed for low health literacy with heavy use of animation and minimal need for reading.”

Wang drew attention to these “significant decrease in decisional conflict” represented by the study’s findings, as well as patients’ “improved AF knowledge” as a result of the shared decision-making intervention. Wang indicated that the novel shared decision-making tool is available for widespread use at afibguide.com and afibguide.com/clinician.

Discussant Christine Albert (Smidt Heart Institute, Los Angeles, USA) suggested that future studies of the tool should examine its “performance among populations with lower health literacy and evaluate the impact of longer-term compliance” beyond the six months covered by the trial. She also added that “larger-scale studies will be needed to determine if decision aids for OAC use in AF improve hard outcomes of stroke and bleeding.”


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