Why the study?
What are older patients' preferences regarding the use of warfarin to prevent atrial fibrillation-related strokes when presented with risks and benefits?
What are older patients' preferences regarding the use of warfarin to prevent atrial fibrillation-related strokes when presented with risks and benefits?
A significant proportion of older patients may decline warfarin therapy for stroke prevention when fully informed of the cumulative risks of intracerebral hemorrhage, emphasizing the importance of shared decision-making.
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Highlights potential barriers to informed warfarin use in older AF patients; leaves open optimal shared decision-making approaches for prospective validation.
OBJECTIVE: To examine older patients' preferences regarding the use of warfarin to prevent atrial fibrillation related strokes when faced with cumulative probabilities of treatment risk and benefit. DESIGN: A semi-qualitative researcher administered questionnaire and interview. SUBJECTS: 81 patients attending a general elderly medicine outpatient clinic. RESULTS: Up to 50% of participants would decline warfarin treatment when shown both cumulative benefits of stroke risk reduction and risk of intracerebral haemorrhage. Principal themes highlighted concepts of gambling and trade offs relating to risk and benefit. Attitudes about stroke and negative perceptions of intracerebral haemorrhage were major contributory themes in the decision to refuse warfarin treatment. CONCLUSION: Older people use very individualistic health beliefs in judging how to trade risks to preserve quality of life. Carefully explaining risk information and listening to elders' views and reasoning is likely to result in a more informed choice regarding the use of anticoagulation in stroke prevention.
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Richard Fuller (2004) studied this question.
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