Stroke Reduction Therapies, Shared Decision-Making, and Patient Decision Aids: An Opportunity for Improved Quality...

Atrial fibrillation (AF) is associated with 20% of the ischemic strokes in the United States. Atrial fibrillation related ischemic strokes can be reduced by pharmacologic and non-pharmacologic therapies. The decision-making process for selecting stroke reduction therapies is complex and should be individualized based on patient preferences and values, the risk and benefits of treatment, and the impact on the quality of life. Shared decision-making (SDM) operationalized through patient decision aids (PDAs) provides an opportunity to improve the decision-making process for stroke reduction therapies used in AF. Unfortunately, a limited number of PDAs for stroke reduction therapies in AF exist. Furthermore, it is unclear whether these aids were created in an evidence-based fashion and tailored to specific populations.

This perspective advocates for future amendments to the International Patient Decision Aids Standards (IPDAS) and the National Standards for the Certification of Patient Decision Aids that will facilitate the creation of evidenced based PDAs that move beyond a one-size fits all approach. Specifically, creation of diverse stakeholder advisory teams that utilize usability testing to create decision aids that are culturally responsive and perhaps tailored to vulnerable populations. Racial and ethnic minoritized populations with AF have the highest burden of poor outcomes. Black patients with AF had a twofold higher rate of stroke versus White patients (27.2 vs. 12.8 per 1000 per years) in the Atherosclerosis Risk in Communities Study. We hypothesize that SDM operationalized through PDAs has the chance to potentially reduce racial and ethnic disparities in the utilization of different stroke reduction therapies for AF.

The process of SDM conducted via PDAs can improve the decision-making process for stroke reduction therapies in AF. Future studies should assess the feasibility of creating culturally tailored decision aids as well as their effectiveness in increasing the uptake of stroke reduction therapies.