Antithrombotic treatment for atrial fibrillation

Editor—The findings of Howitt and Armstrong’s study of antithrombotic treatment for atrial fibrillation in general practice—in particular that patients were unwilling to take warfarin—have uncertain clinical relevance.1 They are in contrast to those of Sudlow et al, who reported that most elderly patients with atrial fibrillation would accept treatment to prevent stroke.2 The precise information provided to patients is critically important in influencing their beliefs. Lack of detail on the information provided about the drugs mars Howitt and Anderson’s study. The authors emphasised the value of a patient centred approach in determining antithrombotic treatment in chronic atrial fibrillation and presented to patients, in pictorial fashion, the benefits (derived from clinical trials) of warfarin and aspirin. An equally important methodological issue, however, is the presentation of the risks of the treatment. The methods section states only that “detailed information about aspirin and warfarin treatment was given.” What exactly does this mean? If the material consisted of the typical prescribing information for warfarin or even the equally daunting consumer drug information developed by pharmaceutical companies, it is not surprising that many patients were frightened off treatment. Adopting a patient centred approach to therapeutic decision making requires that the potential risks of the treatment are presented in as patient friendly a manner as the possible benefits.