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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Patients' views on stroke prevention for atrial fibrillation after an intracerebral haemorrhage: a qualitative study
Elena Ivany1,2,3, Robyn R Lotto1,4, Gregory Y H Lip1,2,5
1Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University, and Liverpool Heart and Chest Hospital, Liverpool, UK.
Insights
Patients with atrial fibrillation (AF) and a history of stroke (ICH) prioritize quality of life when deciding on oral anticoagulation (OAC). Individual, medical, and social factors influence their choices for stroke prevention.
Area of Science:
- Cardiology
- Neurology
- Patient Decision-Making
Background:
- Atrial fibrillation (AF) increases stroke risk, necessitating oral anticoagulation (OAC).
- Intracerebral hemorrhage (ICH) survivors face complex decisions regarding OAC for secondary stroke prevention.
- Understanding patient perspectives is crucial for effective stroke prevention strategies.
Purpose of the Study:
- To explore patient attitudes towards OAC for stroke prevention after ICH.
- To identify factors influencing patient decision-making regarding OAC post-ICH.
Main Methods:
- Purposive sampling of 12 patients with AF and prior ICH from eight English hospitals.
- Semi-structured interviews to gather data.
- Framework analysis to interpret patient decision-making factors.
Main Results:
- Patients' primary concern is maintaining an acceptable quality of life ('Living my life as normal').
- Decision-making is influenced by individual attitudes, medical factors (trust, information seeking), and social support networks.
- Key factors include personal health beliefs, trust in medical advice, and influence of social circles.
Conclusions:
- Patient decisions on OAC for AF post-ICH are shaped by individual, medical, and social considerations.
- Maintaining quality of life is central to patient decision-making.
- Findings support healthcare professionals in facilitating shared decision-making for stroke prevention.
Aim:
(i) To explore the attitudes of patients with atrial fibrillation (AF) towards oral anti-coagulation (OAC) for stroke prevention post-intracerebral haemorrhage (ICH) and (ii) to explore factors that influence patients' decision-making process for stroke prevention.
Methods And Results:
Patients with documented diagnosis of AF and history of a non-traumatic ICH, who were eligible for long-term OAC were recruited from eight hospitals in England, using purposive sampling. Data were collected using semi-structured interviews and analysed using Framework analysis. Twelve patients (mean (SD) age 76.2 (6.6) years; 9 men) were recruited. Patients' main priority was to maintain an acceptable quality of life (QoL), reflected by the main theme 'Living my life as normal'. When deciding to accept or decline OAC for stroke prevention, patients were influenced by the following: (i) The individual, meaning factors relating to individuals' personal attitudes towards health and healthcare, (ii) Medical factors, encompassing factors relating to patients' trust in medical expertise and patients' information-seeking behaviours, and (iii) Social factors, highlighting the influence of patients' social support network on patients' decision-making.
Conclusion:
Patients' decision-making for stroke prevention for AF post-ICH was influenced by individual, medical, and social factors. At the heart of patients', decision-making were concerns with maintaining an acceptable QoL. The study findings help nurses and other healthcare professionals to better understand what matters to patients who are eligible for stroke prevention for AF post-ICH, thus promoting more effective shared decision making.
