A self-administered patient decision aid resulted in a 12% absolute improvement in the proportion of patients with nonvalvular atrial fibrillation receiving appropriate antithrombotic therapy at 3 months compared to usual care.
RCT (n=434)
Single-blind
Cluster randomization
Yes
Does a patient decision aid improve the appropriateness of antithrombotic therapy in patients with nonvalvular atrial fibrillation?
A patient decision aid provided a short-term, but not long-term, improvement in the appropriateness of antithrombotic therapy for patients with nonvalvular atrial fibrillation.
Effect estimate: 12% absolute improvement
Absolute Event Rate: 9% vs -3%
p-value: p=0.03
BACKGROUND: Too few patients with nonvalvular atrial fibrillation (NVAF) receive appropriate antithrombotic therapy. We tested the short-term (primary outcome) and long-term (secondary outcome) effect of a patient decision aid on the appropriateness of antithrombotic therapy among patients with NVAF. METHODS: We conducted a cluster randomized trial with blinded outcome assessment involving 434 NVAF patients from 102 community-based primary care practices. Patients in the intervention group received a self-administered booklet and audiotape decision aid tailored to their personal stroke risk profile. Patients in the control group received usual care. The primary outcome measure was change in antithrombotic therapy at 3 months. Appropriateness of therapy was defined using the American College of Chest Physicians (ACCP) recommendations. RESULTS: The mean patient age was 72 years, and the median duration of NVAF was 5 years. In the control group, there was a 3% decrease over 3 months in the number of patients receiving therapy appropriate to their risk of stroke (40% 85/215 at baseline v. 37% 79/215 at 3 months). In the intervention group, the number of patients receiving therapy appropriate to their stroke risk increased by 9% (32% 69/219 at baseline v. 41% 89/219 at 3 months). Although the proportion of patients whose therapy met the ACCP treatment recommendations did not differ between study arms at baseline (p = 0.11) or 3 months (p = 0.44), there was a 12% absolute improvement in the number of patients receiving appropriate care in the intervention group compared with the control group at 3 months (p = 0.03). The beneficial effect of the decision aid did not persist (p = 0.44 for differences between study arms after 12 months). INTERPRETATION: There was short-term improvement in the appropriateness of antithrombotic care among patients with NVAF who were exposed to a decision aid, but the improvement did not persist.
Finlay A. McAlister (Mon,) conducted a rct in Nonvalvular atrial fibrillation (n=434). Patient decision aid vs. Usual care was evaluated on Change in the proportion of patients taking antithrombotic therapy deemed appropriate to their risk of stroke at 3 months (12% absolute improvement, p=0.03). A self-administered patient decision aid resulted in a 12% absolute improvement in the proportion of patients with nonvalvular atrial fibrillation receiving appropriate antithrombotic therapy at 3 months compared to usual care.
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