Key result
Patient decision aids for stroke prevention in atrial fibrillation increased patients' knowledge and decisional confidence but had variable and inconclusive impacts on the choice of and adherence to therapy.
Why the study?
Oral anticoagulation reduces AF-associated stroke risk but remains underused, making preference-sensitive stroke prevention therapy a target for patient decision aids whose effectiveness on therapy choice and adherence needed summarization.
Do patient decision aids improve stroke prevention therapy choice, adherence, decisional conflict, and patient knowledge in adults with nonvalvular atrial fibrillation?
Systematic Review (n=2,153)
Do patient decision aids improve stroke prevention therapy choice, adherence, decisional conflict, and patient knowledge in adults with nonvalvular atrial fibrillation?
Patient decision aids for stroke prevention in atrial fibrillation increase patient knowledge and decisional confidence, but have variable impacts on actual therapy choice and adherence.
Decision aids boost knowledge and confidence in AF but not therapy choice or adherence; confirms educational value yet leaves open effects on clinical outcomes.
Background: Atrial Fibrillation (AF) is a major cause of stroke. Oral anticoagulation can reduce the risk of AF-associated stroke by 65% but it remains underused. Stroke prevention therapy in patients with AF has been considered a good target for shared decision making with patient decision aids as it is a long-term, preference-sensitive decision with known risk-benefit trade-offs. The aim of this systematic review was to summarize published literature on the effectiveness of patient decision aids on the choice of and adherence to stroke prevention therapy in individuals with AF. Methods: We conducted a structured literature search for prospective studies evaluating decision aids for AF stroke prevention therapy in adult patients with nonvalvular AF. We included studies that compared those exposed to a decision aid with a control condition for outcomes including choice of therapy, adherence, decisional conflict and patient knowledge. Quantitative meta-analysis was not feasible due to excessive between-study heterogeneity. Results: Eight studies met inclusion and exclusion criteria. Six studies were randomized clinical trials and two were pre-post comparisons. Of the 8 studies, each evaluated a different decision aid, with only three including all contemporary oral anticoagulant drugs. All decision aids improved AF knowledge compared to baseline or control and decision aids reduced decisional conflict in four of six studies. However, there were inconsistent effects of the studied decision aids on initiation of oral anticoagulation. Adherence to initial stroke prevention therapy choice appeared to benefit from decision aid use in 2 studies that addressed this issue. Conclusions: Decision aids for stroke prevention increased AF patients' knowledge and decisional confidence but had variable impacts on choice of and adherence to stroke prevention therapy. The results highlight the need for well-designed decision aids that present patients with all contemporary therapeutic options.
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Baers et al. (2022) conducted a systematic review in Nonvalvular Atrial Fibrillation (n=2,153). Patient decision aids vs. Usual care or clinical practice guidelines was evaluated on Choice of and adherence to stroke prevention therapy. Patient decision aids for stroke prevention in atrial fibrillation increased patients' knowledge and decisional confidence but had variable and inconclusive impacts on the choice of and adherence to therapy.
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