Shared Decision-Making and Patient Decision Aids for Percutaneous Left Atrial Appendage Occlusion

Area of Science:

• Cardiology
• Health Services Research
• Patient Engagement

Background:

• Shared decision-making (SDM) is recommended before percutaneous left atrial appendage occlusion (pLAAO) for atrial fibrillation patients.
• Centers for Medicare & Medicaid Services (CMS) mandate SDM with patient decision aids (DAs) for pLAAO reimbursement.
• Current practice patterns regarding SDM and DA use for pLAAO remain largely uncharacterized.

Purpose of the Study:

• To assess trends in reported SDM and DA use for pLAAO procedures.
• To identify patient, operator, and institutional factors influencing SDM and DA utilization.

Main Methods:

• A cohort study analyzed data from October 2022 to June 2024 from the NCDR LAAO Registry.
• Included patients undergoing their first pLAAO procedure.
• Hierarchical logistic regression examined factors associated with SDM plus DA reporting.

Main Results:

• Over 147,000 patient encounters were analyzed; 64.7% reported SDM plus DA use initially, rising to 75.0% by June 2024.
• Significant institutional variation in SDM plus DA reporting was observed (mean probability 52.0%, range 0.1%-76.4%).
• No significant difference in SDM plus DA odds was found for Medicare vs. non-Medicare patients.

Conclusions:

• While SDM plus DA reporting for pLAAO is substantial, institutional disparities are considerable.
• CMS requirements do not appear to equalize SDM plus DA use across patient groups.
• Further research into institutional barriers and facilitators for SDM and DA implementation is warranted.