Shared decision-making in atrial fibrillation: navigating complex issues in partnership with the patient
Open accessAbstract
Atrial fibrillation (AF) is an important risk factor for stroke. Although anticoagulation is effective in mitigating this risk, many high-risk patients are not anticoagulated in routine practice. Furthermore, as many as 50% of those who are prescribed an anticoagulant stop treatment within a year. This under treatment may be due, in part, to difficulty in navigating difficult decisions about initiating potentially lifelong therapy with significant costs, potential risks, and impact on daily life. To address these challenges, the most recent American guidelines issued a class I recommendation to use shared decision-making (SDM) to individualize patients' antithrombotic care. The call by the major cardiovascular organizations for SDM is in an effort to improve quality of care by promoting decisions that reflect what is best for an individual patient based on their stroke and bleeding risks, as well as their comorbid conditions and socio-personal context. SDM is readily applicable to current cardiovascular practice, but ongoing work will be needed to determine whether brief, evidence-based, and patient-oriented tools are able to support thoughtful, patient-centered decision-making and, ultimately, improve the rates of appropriate treatment initiation and adherence.
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Conversation aids are designed for use within the clinical encounter to guide patient and clinician through shared decision-making, unlike patient decision aids.
“Unlike patient decision aids (which are used by the patient in preparation prior to the clinical encounter), conversation aids are designed for use within the clinical encounter to guide the patient and clinician through the shared decision-making process [28, 30].”
From Explainability for artificial intelligence in healthcare: a multidisciplinary perspective (2020) · cites this paper as [28]
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Explainability for artificial intelligence in healthcare: a multidisciplinary perspective
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- Authors
- Noseworthy, P. A., Brito, J. P., Kunneman, M., Hargraves, I. G., Zeballos-Palacios, C., Montori, V. M., & Ting, H. H.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Noseworthy, Peter A.
- ORCID
- Venue
- Journal of Interventional Cardiac Electrophysiology
- Published
- 2018-10-17
- Volume
- 56
- Issue
- 2
- Pages
- 159-163
- ISSN
- 1383-875X (ISSN-L)
- 1572-8595
- PMC
- PMC7056296
- OpenAlex
- W2897445325
- Cited by
- 25
- References
- 28
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 1 · 2023: 3 · 2022: 5 · 2021: 3 · 2020: 5
- FWCI
- 1.51
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of Interventional Cardiac Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL131535)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- shared decision-making, atrial fibrillation, anticoagulation, stroke prevention, antithrombotic therapy, treatment initiation, medication adherence, bleeding risk, patient-centered care, patient decision aids, guideline recommendations
- MeSH terms
- Decision Making, Shared, Anticoagulants, Atrial Fibrillation, Humans, Physician-Patient Relations, United States, Practice Guidelines as Topic, Stroke
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