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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Effectiveness of shared decision making strategies for stroke prevention among patients with atrial fibrillation:

Elissa M Ozanne1, Geoffrey D Barnes2, Juan P Brito3

  • 1Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA elissa.ozanne@hsc.utah.edu.

BMJ (Clinical Research Ed.)
|January 9, 2025
PubMed

Insights

Decision aids for stroke prevention in non-valvular atrial fibrillation significantly improve shared decision-making, patient knowledge, and reduce decisional conflict. Using these aids, alone or combined, offers advantages over usual care.

Area of Science:

  • Cardiology
  • Health Services Research
  • Patient Decision Making

Background:

  • Non-valvular atrial fibrillation (NVAF) poses a significant stroke risk.
  • Effective stroke prevention in NVAF requires shared decision-making between patients and clinicians.
  • Existing decision support tools may vary in their impact on shared decision-making quality.

Purpose of the Study:

  • To assess the effectiveness of patient decision aids and clinician encounter decision aids in enhancing shared decision-making for stroke prevention in NVAF patients.
  • To evaluate the impact of these decision aids on patient knowledge and decisional conflict.

Main Methods:

  • A cluster randomized controlled trial involving 1117 patients with NVAF across six US academic medical centers.
  • Patients and clinicians were randomized to receive either a decision aid (patient-facing or clinician-facing) or usual care.
  • Primary outcomes included quality of shared decision-making (OPTION12), patient knowledge, and decisional conflict.

Main Results:

  • Combined use of patient and encounter decision aids significantly improved shared decision-making quality, patient knowledge, and reduced decisional conflict compared to usual care.
  • Both patient decision aids and encounter decision aids used individually also showed significant benefits for shared decision-making and knowledge.
  • No significant differences were found in treatment choices or patient satisfaction, nor in visit length.

Conclusions:

  • Decision aids, whether patient-facing, clinician-facing, or combined, enhance shared decision-making, patient knowledge, and reduce decisional conflict in NVAF stroke prevention.
  • The study demonstrates the advantage of using pre-visit or in-visit decision aids over usual care.
  • These findings support the integration of decision aids into clinical practice for NVAF management.
Abstract

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