Patient-Centered Shared Decision Strategies for Stroke Prevention in Atrial Fibrillation

Atrial fibrillation is the most common heart rhythm disorder in adults and a leading preventable cause of ischemic stroke. Currently, over 37 million people worldwide have atrial fibrillation, and this number is projected to rise to more than 62 million by 2050. 

People with atrial fibrillation face a four- to five-fold higher risk of stroke compared with those without the condition, and strokes related to atrial fibrillation are often more severe.

Shared decision-making is recommended in major clinical guidelines to help patients and clinicians make joint decisions about anticoagulation, incorporating both medical evidence and patient preferences. Tools such as patient decision aids, used before appointments, and encounter decision aids, used during visits, have been developed to facilitate this process.

A cluster randomized trial conducted at six academic medical centers in the United States assessed the effectiveness of these strategies in patients with non-valvular atrial fibrillation at elevated stroke risk (CHA2DS2-VASc ≥1 for men, ≥2 for women). Patients were assigned to receive a patient decision aid or usual care, while clinicians were assigned to use an encounter decision aid or usual care. Outcomes measured included quality of shared decision-making, patient knowledge, and decisional conflict.

Among 1117 participants, combining patient and encounter decision aids improved shared decision-making, knowledge, and reduced decisional conflict compared with usual care. The encounter decision aid alone improved all outcomes, while the patient decision aid alone improved decision-making and knowledge. Treatment choices, satisfaction, and visit length were similar across groups.

 These findings support the use of decision aids to enhance shared decision-making with minimal impact on workflow.

References:

1. Ozanne EM, Barnes GD, Brito JP, Cameron KA, Cavanaugh KL, Greene T, et al. Effectiveness of shared decision making strategies for stroke prevention among patients with atrial fibrillation: cluster randomized controlled trial. BMJ. 2025;388:e079976. doi:10.1136/bmj-2024-079976; https://www.bmj.com/content/388/bmj-2024-079976