Need for Engagement in Stroke Prevention Shared Decision-Making in Older Adults with Atrial Fibrillation and Multimorbidity

Aim: To assess the prevalence of older adults with AF and multimorbidity expressing a need for greater involvement in SDM for stroke prevention and associated patient characteristics. Methods: A prospective cohort study (2016-2018) enrolled patients aged 65 years and older with AF from clinics in MA and Georgia. Participants with one or more chronic conditions were included in this study. To assess patient preferences for greater engagement in SDM, participants on oral anticoagulants were asked at the one-year follow-up if they would like to be more involved in deciding to take an anticoagulant and which oral anticoagulant to use for stroke prevention. Multivariable logistic regression analysis was used to identify patient characteristics associated with preference for more SDM engagement. Results: = 532; mean age: 75 years; 48% women, 87% White), 41% had 1-4 chronic conditions, 40% had 5-7, and 19% had 8 or more. Approximately one-third expressed a preference for both engaging in SDM on anticoagulation initiation and choosing the type of anticoagulant for stroke prevention. After multivariable adjustment, participants who were younger (aged 65-74 years), women, non-White, had less than high school education, higher perceived burden from anticoagulation use, or had fewer comorbidities, were more likely to report the need for greater SDM engagement for stroke prevention. Conclusions: Clinicians should recognize the specific needs of older patients with AF and multimorbidity that seek greater involvement in SDM for stroke prevention. Providing tailored interventions can enhance stroke prevention decision-making in this vulnerable population.