title: Values and preferences for oral antithrombotic therapy in patients with atrial fibrillation: physician and patient perspectives.
abstract: BACKGROUND
  Exploration of values and preferences in the context of anticoagulation therapy for atrial fibrillation (AF) remains limited. To better characterize the distribution of patient and physician values and preferences relevant to decisions regarding anticoagulation in patients with AF, we conducted interviews with patients at risk of developing AF and physicians who manage patients with AF.
  
  
  METHODS
  We interviewed 96 outpatients and 96 physicians in a multicenter study and elicited the maximal increased risk of bleeding (threshold risk) that respondents would tolerate with warfarin vs. aspirin to achieve a reduction in three strokes in 100 patients over a 2-year period. We used the probabilistic version of the threshold technique.
  
  
  RESULTS
  The median threshold risk for both patients and physicians was 10 additional bleeds (10 P = 0.7). In both groups, we observed large variability in the threshold number of bleeds, with wider variability in patients than clinicians [patient range: 0-100, physician range: 0-50]. We observed one cluster of patients and physicians who would tolerate <10 bleeds and another cluster of patients, but not physicians, who would accept more than 35.
  
  
  CONCLUSIONS
  Our findings suggest wide variability in patient and physician values and preferences regarding the trade-off between strokes and bleeds. Results suggest that in individual decision making, physician and patient values and preferences will often be discordant; this mandates tailoring treatment to the individual patient's preferences.
authors.affiliation: Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Alonso-Coello
authors.affiliation: Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, MN, USA.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.affiliation: Unidad Docente de Medicina Familiar y Comunitaria, Hospital Donostia, Donostia, Spain.
authors.forename: M Gloria
authors.initials: MG
authors.lastname: Díaz
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, CLARITY Research Group, McMaster University Medical Centre 2C9, Hamilton, ON, Canada.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Devereaux
authors.affiliation: Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Mas
authors.affiliation: Centro de Salud de Beraun, Errenteria, San Sebastián, Spain.
authors.forename: Ana I
authors.initials: AI
authors.lastname: Diez
authors.affiliation: Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain.
authors.forename: Ivan
authors.initials: I
authors.lastname: Solà
authors.affiliation: SAP Litoral de Barcelona, Barcelona, Spain.
authors.forename: Mercè
authors.initials: M
authors.lastname: Roura
authors.affiliation: Unitat d'Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Souto
authors.affiliation: Unidad Formadora de Medicina Familiar y Comunitaria de A Coruña, Coruña, Spain.
authors.forename: Sven
authors.initials: S
authors.lastname: Oliver
authors.affiliation: Institut Català de la Salut, Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Ruiz
authors.affiliation: Hospital Clínic, Barcelona, Spain.
authors.forename: Blanca
authors.initials: B
authors.lastname: Coll-Vinent
authors.affiliation: Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain.
authors.forename: Ignasi
authors.initials: I
authors.lastname: Gich
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, CLARITY Research Group, McMaster University Medical Centre 2C9, Hamilton, ON, Canada.
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Schünemann
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, CLARITY Research Group, McMaster University Medical Centre 2C9, Hamilton, ON, Canada.
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D057240:Patient Preference; D010820:Physicians; D018570:Risk Assessment; D020521:Stroke / Q000517:prevention & control; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D014859:Warfarin; D001241:Aspirin
keywords: anticoagulation; antithrombotic treatment; decision making; preferences; values