Key result
AF patients with prior ICH prioritize quality of life when deciding on OAC.
Why the study?
Patients with AF and history of ICH face complex decisions about stroke prevention with OAC, but their attitudes and decision-making factors were not well understood.
What are the attitudes and factors influencing decision-making regarding oral anti-coagulation for stroke prevention in patients with atrial fibrillation post-intracerebral haemorrhage?
What are the attitudes and factors influencing decision-making regarding oral anti-coagulation for stroke prevention in patients with atrial fibrillation post-intracerebral haemorrhage?
In patients with AF and prior ICH, decision-making regarding OAC is complex and heavily influenced by the desire to maintain quality of life, highlighting the need for personalized shared decision-making.
Patient views on OAC post-ICH should guide shared decisions; leaves open need for prospective outcome trials.
AIM: (i) To explore the attitudes of patients with atrial fibrillation (AF) towards oral anti-coagulation (OAC) for stroke prevention post-intracerebral haemorrhage (ICH) and (ii) to explore factors that influence patients' decision-making process for stroke prevention. METHODS AND RESULTS: Patients with documented diagnosis of AF and history of a non-traumatic ICH, who were eligible for long-term OAC were recruited from eight hospitals in England, using purposive sampling. Data were collected using semi-structured interviews and analysed using Framework analysis. Twelve patients (mean (SD) age 76.2 (6.6) years; 9 men) were recruited. Patients' main priority was to maintain an acceptable quality of life (QoL), reflected by the main theme 'Living my life as normal'. When deciding to accept or decline OAC for stroke prevention, patients were influenced by the following: (i) The individual, meaning factors relating to individuals' personal attitudes towards health and healthcare, (ii) Medical factors, encompassing factors relating to patients' trust in medical expertise and patients' information-seeking behaviours, and (iii) Social factors, highlighting the influence of patients' social support network on patients' decision-making. CONCLUSION: Patients' decision-making for stroke prevention for AF post-ICH was influenced by individual, medical, and social factors. At the heart of patients', decision-making were concerns with maintaining an acceptable QoL. The study findings help nurses and other healthcare professionals to better understand what matters to patients who are eligible for stroke prevention for AF post-ICH, thus promoting more effective shared decision making.
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Ivany et al. (2025) studied Atrial fibrillation and history of non-traumatic intracerebral haemorrhage (n=12). Oral anticoagulation (OAC) was evaluated on Patients' attitudes towards oral anti-coagulation for stroke prevention post-intracerebral haemorrhage and factors influencing decision-making. Patients with atrial fibrillation and prior intracerebral hemorrhage prioritized maintaining an acceptable quality of life when deciding whether to accept oral anticoagulation for stroke prevention.
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