Abstract
BackgroundAtrial fibrillation (AF) is one of the most common predisposing factors for ischemic stroke worldwide. Because of this, patients with AF are prescribed anticoagulant medications to decrease the risk. The availability of different options for oral anticoagulation makes it difficult for some patients to decide a preferred choice of medication. Clinical guidelines often recommend enhancing the decision-making process of patients by increasing their involvement in health decisions. In particular, the use of patient decision aids (PDAs) in patients with AF was associated with increased knowledge and increased likelihood of making a choice. However, the majority of available PDAs are from Western countries.ObjectiveWe aimed to develop and pilot test a PDA to help patients with nonvalvular AF choose an oral anticoagulant for stroke prevention in the local setting. Outcomes were (1) reduction in patient decisional conflict, (2) improvement in patient knowledge, and (3) patient and physician acceptability.MethodsWe followed the International Patient Decision Aid Standards (IPDAS) to develop a mobile app–based PDA for anticoagulation therapy in patients with nonvalvular AF. Focus group discussions identified decisional needs, which were subsequently incorporated into the PDA to compare choices for anticoagulation. Based on recommendations, the prototype PDA was rendered by at least 30 patients and 30 physicians. Decisional conflict and patient knowledge were tested before and after the PDA was implemented. Patient acceptability and physician acceptability were measured after each encounter.ResultsAnticoagulant options were compared by the PDA using three factors that were identified (impact on stroke and bleeding risk, and price). The comparisons were presented as tables and graphs. The prototype PDA was rendered by 30 doctors and 37 patients for pilot testing. The mean duration of the encounters was 15 minutes. The decisional conflict score reduced by 35 points (100-point scale; P<.001). The AF knowledge score improved from 10 to 15 (P<.001). The PDA was acceptable for both patients and doctors.ConclusionsOur study showed that an app-based PDA for anticoagulation therapy in patients with nonvalvular AF (1) reduced patient decisional conflict, (2) improved patient knowledge, and (3) was acceptable to patients and physicians. A PDA is potentially acceptable and useful in our setting. A randomized controlled trial is warranted to test its effectiveness compared to usual care. PDAs for other conditions should also be developed.
Highlights
Atrial fibrillation (AF) is the most common sustained cardiac dysrhythmia [1] and has been recognized as one of the most common causes of ischemic stroke
A focus group discussion International Patient Decision Aid Standards (IPDAS) (FGD) was conducted wherein eight patients participated. They were all diagnosed with nonvalvular AF and were taking anticoagulant medications
Important points that emerged during the discussion were as follows: 1. Participants knew that AF is the irregular beating of the heart, but they were unsure what causes the condition
Summary
Atrial fibrillation (AF) is the most common sustained cardiac dysrhythmia [1] and has been recognized as one of the most common causes of ischemic stroke. The risk of developing a stroke from AF can be decreased with the use of anticoagulation therapy. Multiple drug options with different efficacy and safety profiles exist in the market It is imperative for health care providers to consider their patients’ individual preferences and involve them in the decision-making process. The availability of different options for oral anticoagulation makes it difficult for some patients to decide a preferred choice of medication. Objective: We aimed to develop and pilot test a PDA to help patients with nonvalvular AF choose an oral anticoagulant for stroke prevention in the local setting. Conclusions: Our study showed that an app-based PDA for anticoagulation therapy in patients with nonvalvular AF (1) reduced patient decisional conflict, (2) improved patient knowledge, and (3) was acceptable to patients and physicians.
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