Informed Decision Making for Anticoagulation Therapy for Atrial Fibrillation

Area of Science:

• Cardiology
• Health Services Research
• Patient-Centered Care

Background:

• Patients with atrial fibrillation (AF) face critical choices between warfarin and direct oral anticoagulants (DOACs).
• Informed decision-making is crucial for selecting the appropriate anticoagulant therapy.

Purpose of the Study:

• To evaluate the extent to which physicians engage patients in informed decision-making processes for anticoagulation.
• To identify elements of shared decision-making discussed during patient-physician encounters.

Main Methods:

• Analysis of recorded physician-patient conversations involving anticoagulation-naïve patients.
• Assessment of 7 key elements of informed decision-making and discussion of financial costs.

Main Results:

• Direct oral anticoagulants (DOACs) were prescribed in 92% of encounters, often without comprehensive patient preference assessment.
• Discussions of pros/cons and alternatives occurred in 70% of encounters, but patient role, preferences, and uncertainty were rarely addressed.
• Only 5% of encounters included all 7 elements of informed decision-making; financial costs were discussed in 43%.

Conclusions:

• Physicians frequently present treatment options but fall short in engaging patients in true informed decision-making for anticoagulation.
• The high rate of DOAC prescriptions suggests physician preference, not necessarily shared decision-making, drives treatment selection.
• Strategies are needed to enhance physician-patient shared decision-making for anticoagulant selection in AF patients.