Abstract:
BACKGROUND:Appropriate thromboprophylaxis for patients with atrial fibrillation or atrial flutter (AF) remains a national challenge. METHODS:We hypothesized that a shared decision-making interaction facilitated by an Atrial Fibrillation Shared Decision Making Tool (AFSDM) would improve patient knowledge about atrial fibrillation, and the risks and benefits of various treatment options for stroke prevention; increase satisfaction with the decision-making process; improve the therapeutic alliance between patient and the clinical care team; and increase medication adherence. Using a pre- and post-visit study design, we enrolled 76 patients and completed 2 office visits and 1-month telephone follow-up for 65 patients being seen in our Arrhythmia Clinic over the 1-year period (July 2016 through June 2017). Our primary outcome measure was change in decisional conflict between the first and second clinical visit. RESULTS:Decisional conflict decreased from an average of 31 to 9. Mean change was 22.3 (95% CI, 25.7 - 37.1), corresponding to an effect size of 0.94 standard deviations. Satisfaction with decision increased from 4.0 to 4.5, measures of therapeutic alliance with the care team (Kim Alliance scale) increased from 100.1 to 103.1, and satisfaction with provider increased from 4.2 to 4.5 (P < .0001 for all measures). AF knowledge assessment scores increased from 8.4 to 9.1, and knowledge about personal stroke and bleeding risk increased from 1 to 1.5 (P < .0001). Finally, medication adherence improved as reflected by an increase in the Morisky Medication Adherence scale from 5.9 to 6.4 (P < .0001). CONCLUSIONS:A shared decision-making interaction, facilitated by an AFSDM can significantly improve multiple measures of decision-making quality, leading to improved medication adherence and patient satisfaction.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Eckman MH,Costea A,Attari M,Munjal J,Wise RE,Knochelmann C,Flaherty ML,Baker P,Ireton R,Harnett BM,Leonard AC,Steen D,Rose A,Kues Jdoi
10.1016/j.ahj.2018.01.003subject
Has Abstractpub_date
2018-05-01 00:00:00pages
13-21eissn
0002-8703issn
1097-6744pii
S0002-8703(18)30013-9journal_volume
199pub_type
杂志文章abstract::The effects of captopril (CPT), an oral angiotensin-converting enzyme (ACE) inhibitor, on systemic failure (CHF). In 15 patients, CPT decreased mean arterial pressure from 75 +/- 3 to 60 +/- 3 mm Hg associated with a 16% increase in cardiac output, a 24% reduction in systemic vascular resistance, and a 36% decrease in...
journal_title:American heart journal
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pub_type: 杂志文章,多中心研究
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journal_title:American heart journal
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更新日期:2016-06-01 00:00:00
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pub_type: 杂志文章
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更新日期:1979-03-01 00:00:00
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journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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