Effects of patients' preferences on the treatment of atrial fibrillation: observational study of patient-based decision analysis.
OBJECTIVE
To investigate the effect of patients' preferences in the treatment of atrial fibrillation by using individualized decision analysis in which probability and utility assessments are combined into a decision tree.


METHODS
Observational study based on interviews with patients.


METHODS
8 general practices in Avon, England.


METHODS
260 randomly selected patients aged 70 to 85 years with atrial fibrillation.


METHODS
Patients' treatment preferences regarding anticoagulation treatment (warfarin sodium) after individualized decision analysis; comparison of these preferences with treatment guidelines on the basis of comorbidity and absolute risk and compared with current prescription.


RESULTS
Of 195 eligible patients, 97 participated in decision making using decision analysis. Among these 97, the decision analysis indicated that 59 (61%; 95% confidence interval, 50%-71%) would prefer anticoagulation treatment, considerably fewer than those who would be recommended treatment according to guidelines. There was marked disagreement between the decision analysis and guideline recommendations (kappa> or =0.25). Of 38 patients whose decision analysis indicated a preference for anticoagulation, 17 (45%) were being prescribed warfarin; on the other hand, 28 (47%) of 59 patients were not being prescribed warfarin, although the results of their decision analysis suggested they wanted to be.


CONCLUSIONS
In the context of shared decision making, individualized decision analysis is valuable in a sizable proportion of elderly patients with atrial fibrillation. Taking account of patients' preferences would lead to fewer prescriptions for warfarin than under published recommendations. Decision analysis as a shared decision-making tool should be evaluated in a randomized controlled trial.
Protheroe
J
J
Division of Primary Health Care, Department of Social Medicine, University of Bristol, Bristol BS8 2PR UK.
Fahey
T
T
Montgomery
A A
AA
Peters
T J
TJ
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D016001:Confidence Intervals; D003661:Decision Support Techniques; D004739:England; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010358:Patient Participation; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011336:Probability; D018570:Risk Assessment; D012494:Sampling Studies; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin