Department of Medicine, Division of Cardiovascular Medicine; Department of Population and Quantitative Health Sciences
Cardiovascular Diseases | Epidemiology | Geriatrics | Health Services Administration | Health Services Research | Nervous System Diseases
Objective: To examine the extent of, and factors associated with, patient engagement in shared decision-making (SDM) for stroke prevention among patients with atrial fibrillation (AF).
Methods: We used data from the Systematic Assessment of Geriatric Elements-Atrial Fibrillation study which includes older ( > /=65 years) patients with AF and a CHA2DS2-VASc > /=2. Participants reported engagement in SDM by answering whether they actively participated in choosing to take an oral anticoagulant (OAC) for their condition. Multiple logistic regression was used to assess associations between sociodemographic, clinical, geriatric, and psychosocial factors and patient engagement in SDM.
Results: A total of 807 participants (mean age 75 years; 48% female) on an OAC were studied. Of these, 61% engaged in SDM. Older participants ( > /=80 years) and those cognitively impaired were less likely to engage in SDM, while those very knowledgeable of their AF associated stroke risk were more likely to do so than respective comparison groups.
Conclusions: A considerable proportion of older adults with AF did not engage in SDM for stroke prevention with older patients and those cognitively impaired less likely to do so. Clinicians should identify patients who are less likely to engage in SDM, promote patient engagement, and foster better patient-provider communication which may enhance long-term patient outcomes.
anticoagulation, atrial fibrillation, patient engagement, shared decision-making, stroke
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Copyright © 2021 Author(s). Published by the Canadian Geriatrics Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No-Derivative license (http://creativecommons.org/licenses/by-nc-nd/2.5/ca/), which permits unrestricted non-commercial use and distribution, provided the original work is properly cited.
DOI of Published Version
Mehawej J, Saczynski J, Abu HO, Gagnier M, Bamgbade BA, Lessard D, Trymbulak K, Saleeba C, Kiefe CI, Goldberg RJ, McManus DD. Factors Associated With Patient Engagement in Shared Decision-Making for Stroke Prevention Among Older Adults with Atrial Fibrillation. Can Geriatr J. 2021 Sep 1;24(3):174-183. doi: 10.5770/cgj.24.475. PMID: 34484500; PMCID: PMC8390325. Link to article on publisher's site
Canadian geriatrics journal : CGJ
Mehawej J, Saczynski J, Abu HO, Gagnier M, Bamgbade BA, Lessard DM, Trymbulak K, Saleeba C, Kiefe CI, Goldberg RJ, McManus DD. (2021). Factors Associated With Patient Engagement in Shared Decision-Making for Stroke Prevention Among Older Adults with Atrial Fibrillation. Population and Quantitative Health Sciences Publications. https://doi.org/10.5770/cgj.24.475. Retrieved from https://escholarship.umassmed.edu/qhs_pp/1471