パーキュタヌス左心房付属体の閉塞に対する共同意思決定と患者による意思決定支援
Joshua B Rager1,2, Chien-Yu Huang3, Sarah Zimmerman3
1Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis.
JAMA network open
|February 13, 2026
まとめ
パーキュタヌス左心房付属体の閉塞 (pLAAO) 前での共有意思決定 (SDM) と患者意思決定支援 (DA) の使用は増加したが,機関によって著しく変化した. メディケアの患者は,CMSの要件にもかかわらず,SDM+DAの使用率が高くなかった.
科学分野:
- 心臓病学 心臓病学
- 医療サービス 研究 医療サービス
- 患者との関わり合い
背景:
- 共同意思決定 (SDM) は,心房細動の患者にとって,皮膚経由の左心房付属体の閉塞 (pLAAO) 前に推奨されます.
- メディケア・メディケイドサービスセンター (CMS) は,PLAAOの払い戻しについて,患者による意思決定支援 (DA) をSDMに委託しています.
- pLAAOのためのSDMとDAの使用に関する現在の実践パターンは,大部分が特徴づけられていないままです.
研究 の 目的:
- pLAAOの手続きのための報告されたSDMとDAの使用の傾向を評価する.
- SDMとDAの利用に影響を与える患者,オペレーター,および制度的要因を特定する.
主な方法:
- コホート研究では,NCDR LAAO レジストリから2022年10月から2024年6月までのデータを分析した.
- 最初のPLAAO手術を受けた患者も含まれています.
- 階層的なロジスティック回帰では,SDMとDAの報告に関連した要因を調べました.
主要な成果:
- 14万7000件以上の患者との接触が分析され,64.7%がSDM+DAの使用を報告し,2024年6月までに75.0%に上昇した.
- SDMとDAの報告における重要な制度的変動が観察されました (平均確率は52.0%,範囲は0.1%-76.4%).
- メディケアと非メディケア患者のSDMとDAの確率の有意な差は見つかりませんでした.
結論:
- pLAAOに対するSDM+DAの報告は相当なものだが,制度的な格差は大きい.
- CMSの要件は,患者グループ間でSDM+DAの使用を均等にするようには見えません.
- SDMとDAの実施のための制度的障壁とファシリテーターに関するさらなる研究が必要である.
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