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Updated: Jul 14, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
A patient decision aid to support shared decision-making on anti-thrombotic treatment of patients with atrial
Richard G Thomson1, Martin P Eccles, I Nick Steen
1Institute of Health and Society, University of Newcastle upon Tyne, Newcastle upon Tyne, UK. richard.thomson@newcastle.ac.uk
Insights
A computerised decision aid for atrial fibrillation patients lowered decision conflict and significantly reduced warfarin uptake compared to standard guidelines. This approach positively impacts patient decision-making and treatment choices.
Area of Science:
- Clinical Decision Making
- Health Informatics
- Cardiology
Background:
- Atrial fibrillation (AF) necessitates treatment decisions regarding anticoagulation.
- Warfarin and aspirin are common therapeutic options for AF patients.
- Shared decision-making aids can improve patient understanding and treatment choices.
Purpose of the Study:
- To evaluate the efficacy of a computerised decision aid in AF patients.
- To compare patient decision conflict when using a computerised aid versus standard guidelines.
- To assess the impact on treatment decisions, specifically warfarin initiation.
Main Methods:
- A two-armed, open, exploratory randomised controlled trial.
- 109 AF patients over 60 years old participated.
- Interventions included a computerised decision aid versus paper guidelines in shared decision-making consultations.
Main Results:
- The computerised decision aid group showed lower decision conflict post-consultation (mean difference -0.18).
- Patients in the computerised aid group were significantly less likely to start warfarin (25% vs 93.8%).
- Reduced warfarin uptake was observed in the computerised decision aid arm (RR 0.27).
Conclusions:
- Computerised decision aids enhance shared decision-making in AF patients.
- This technology effectively reduces patient decision conflict.
- The aid significantly decreases the initiation of warfarin, potentially impacting health outcomes.
Objective:
To determine the efficacy of a computerised decision aid in patients with atrial fibrillation making decisions on whether to take warfarin or aspirin therapy.
Design:
Two-armed open exploratory randomised controlled trial.
Setting:
Two research clinics deriving participants from general practices in Northeast England.
Participants:
109 patients with atrial fibrillation aged over 60.
Interventions:
Computerised decision aid applied in shared decision-making clinic compared to evidence-based paper guidelines applied as direct advice.
Main Outcome Measures:
Primary outcome measure was the decision conflict scale. Secondary outcome measures included anxiety, knowledge, decision-making preference, treatment decision, use of primary and secondary care services and health outcomes.
Results:
Decision conflict was lower in the computerised decision aid group immediately after the clinic; mean difference -0.18 (95% CI -0.34 to -0.01). Participants in this group not already on warfarin were much less likely to start warfarin than those in the guidelines arm (4/16, 25% compared to the guidelines group 15/16, 93.8%, RR 0.27, 95% CI 0.11 to 0.63).
Conclusions:
Decision conflict was lower immediately following the use of a computerised decision aid in a shared decision-making consultation than immediately following direct doctor-led advice based on paper guidelines. Furthermore, participants in the computerised decision aid group were significantly much less likely to start warfarin than those in the guidelines arm. The results show that such an approach has a positive impact on decision conflict comparable to other studies of decision aids, but also reduces the uptake of a clinically effective treatment that may have important implications for health outcomes.
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