A Patient Decision Aid for Anticoagulation Therapy in Patients With Nonvalvular Atrial Fibrillation: Development and...

Area of Science:

• Cardiology
• Health Informatics
• Patient Decision Making

Background:

• Atrial fibrillation (AF) is a major risk factor for ischemic stroke, necessitating anticoagulant therapy.
• Choosing among oral anticoagulants presents a challenge for patients due to multiple options.
• Patient decision aids (PDAs) can enhance informed decision-making, but culturally relevant tools are scarce.

Purpose of the Study:

• To develop and pilot test a mobile app-based PDA for patients with nonvalvular AF.
• To assess the PDA's impact on patient decisional conflict and knowledge.
• To evaluate patient and physician acceptability of the PDA.

Main Methods:

• Developed a mobile app-based PDA following IPDAS guidelines.
• Incorporated patient-identified decisional needs into the PDA's comparison features.
• Pilot tested the PDA with 30 physicians and 37 patients, measuring decisional conflict and knowledge before and after use.

Main Results:

• The PDA compared anticoagulant options based on stroke risk, bleeding risk, and price.
• Patient decisional conflict scores decreased significantly (35 points, P<.001).
• Patient knowledge scores improved significantly (from 10 to 15, P<.001), with high acceptability among patients and physicians.

Conclusions:

• An app-based PDA effectively reduced decisional conflict and improved knowledge for nonvalvular AF patients choosing anticoagulants.
• The PDA demonstrated acceptability and utility in the local setting.
• Further randomized controlled trials are recommended to confirm effectiveness against usual care.