A Web-Based Tool to Perform a Values Clarification for Stroke Prevention in Patients With Atrial Fibrillation: Design...

Area of Science:

• Cardiology
• Medical Decision Making
• Health Communication

Background:

• Atrial fibrillation (AF) increases stroke risk, necessitating oral anticoagulation (OAC) for prevention.
• OAC use carries an increased risk of bleeding, creating a complex risk-benefit balance.
• Clinical guidelines offer limited direction for OAC decisions in patients with borderline stroke risk.

Purpose of the Study:

• To assess if visual aids and values clarification exercises improve understanding of OAC trade-offs in AF patients.
• To evaluate the impact of different visualization methods (gauge vs. icon array) on decision-making.

Main Methods:

• 673 participants aged 45-64 without AF or OAC use were surveyed.
• Participants were randomized to standard text, visual aids, or visual aids with values clarification.
• Decision confidence (SURE test), perceived stroke risk reduction, and OAC likelihood were primary outcomes.

Main Results:

• Visual aids and values clarification did not significantly increase decision confidence (SURE test scores).
• Participants were less likely to choose OAC and perceived lower stroke risk reduction with visual aids.
• Icon array visualizations led to higher OAC likelihood and perceived stroke risk reduction compared to gauge displays.

Conclusions:

• Visual aids modestly influence decision confidence and OAC benefit perception but not overall decision certainty.
• The choice between OAC and no OAC for stroke prevention in AF remains complex, especially with borderline risk.
• Further research is needed to optimize visual aids for informed decision-making in AF stroke prevention.