Abstract 13111: Factors Associated With Patient Engagement in Shared Decision-Making for Stroke Prevention Among Older Adults With Atrial Fibrillation: Implications for Patient-Provider Communication

Abstract

Introduction: Though engaging patients with atrial fibrillation (AF) in the decision-making process for stroke prevention is encouraged by guidelines, little is known about the extent of, and the factors associated with, patient engagement in this process. Hypothesis: Patient engagement in shared decision-making (SDM) would be modest and that older participants will less likely engage in SDM for stroke prevention. Methods: Data are from the ongoing SAGE (Systematic Assessment of Geriatric Elements)-AF study which enrolled older adults aged 65 years and older with AF from clinics in Massachusetts and Georgia. Participants on an oral anticoagulant (OAC) reported whether they were engaged in the decision to be on an OAC by answering “Yes” to the question: “Did you participate actively in choosing to take an OAC?”. We used multiple logistic regression analysis to examine the sociodemographic, geriatric, psychosocial, and clinical factors associated with patient engagement in SDM for stroke prevention. Results: Participants (N= 807) were on average 75 years old and 48% were female. Approximately, 61% engaged in the decision to be on an OAC. Participants aged 80 years and older (aOR= 0.53; 95 % CI:0.31-0.89) and those cognitively impaired (aOR= 0.69; 95 % CI: 0.48, 0.99) were less likely to engage in SDM than respective comparison groups. Participants who reported being very knowledgeable of their AF associated risk of stroke had higher odds of engaging in SDM than those with less knowledge (aOR= 3.06; 95 % CI:1.59, 5.90). Conclusions: Clinicians should identify older patients and those who are cognitively impaired who are less likely to engage in SDM for stroke prevention, promote patient engagement, and provide support to ensure sustained engagement that would enhance long-term treatment outcomes for patients with AF.