Oral anticoagulation (OAC) therapy is known to reduce the risk of stroke in patients with atrial fibrillation (AF) but is underutilized.^1,2 Patients are often poorly informed of the risks and benefits of anticoagulants, leading to decision-making conflict.³ Uncertainty around individualized treatment plans decreases overall adherence and patient satisfaction.⁴ The goal of the Chiu et al. study was to create a tool to aid in joint provider and patient OAC decision-making confidence and understanding. The consensus, based on the results of this study, was that a shared decision-making (SDM) toolkit led to significantly less decisional conflict compared with the usual care strategy.⁴

This study introduced a valuable toolkit aimed at enhancing informed decision-making strategies for patients with AF who are considering OACs, consisting of an auxiliary tool ("Shall I take oral anticoagulants to prevent stroke if I have AF?") that includes 20-30 min of one-on-one, in-person professional counseling and education in addition to an SDM questionnaire completed before and after counseling to document patients' perceptions of anticoagulants. Although the study focused primarily on the SDM process, it provided an opportunity for further exploration into how this process compares with the usual care method. Interestingly, the study results showed no significant difference in decisional regret at 6 months or in perceived clinician respect, indicating similar levels of long-term decision satisfaction across groups. Furthermore, the study results highlighted a comprehensive approach to improving patients' understanding of anticoagulation therapy's risks and benefits.

More work must be done to determine the association between the SDM anticoagulation toolkit and its effect on outcomes for patients with AF or their long-term medication adherence. However, this study opened the door for future research to explore the toolkit's impact on patient outcomes and medication adherence in patients with AF.

References

1. Al-Khatib SM, Pokorney SD, Al-Khalidi HR, et al. Underuse of oral anticoagulants in privately insured patients with atrial fibrillation: a population being targeted by the IMplementation of a randomized controlled trial to imProve treatment with oral AntiCoagulanTs in patients with Atrial Fibrillation (IMPACT-AFib). Am Heart J. 2020;229:110-117. doi:10.1016/j.ahj.2020.07.012
2. Writing Committee Members, Joglar JA, Chung MK, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines [published correction appears in J Am Coll Cardiol. 2024 Mar 5;83(9):959. doi: 10.1016/j.jacc.2024.01.020.] [published correction appears in J Am Coll Cardiol. 2024 Jun 25;83(25):2714. doi: 10.1016/j.jacc.2024.05.033.]. J Am Coll Cardiol. 2024;83(1):109-279. doi:10.1016/j.jacc.2023.08.017
3. Yao C, Jones AE, Slager S, Fagerlin A, Witt DM. Exploring clinician perspectives on patients with atrial fibrillation who are not prescribed anticoagulation therapy. PEC Innov. 2022;1:100062. Published 2022 Jun 30. doi:10.1016/j.pecinn.2022.100062
4. Chiu HH, Chang SL, Cheng HM, et al. Shared decision making for anticoagulation reduces anxiety and improves adherence in patients with atrial fibrillation. BMC Med Inform Decis Mak. 2023;23(1):163. Published 2023 Aug 22. doi:10.1186/s12911-023-02260-x