title: Patient preferences regarding atrial fibrillation stroke prophylaxis in patients at potential risk of atrial fibrillation.
abstract: Background With an increasing number of options for atrial fibrillation (AF) stroke prophylaxis, there are several medication-related factors to consider. This study aimed to gain a better understanding of which preference factors influence patient decisions when selecting AF stroke prophylaxis. Objective To determine the factors that influence patient stroke prophylaxis decisions and preferred therapeutic options. Methods A questionnaire about AF stroke prophylaxis medication options was distributed to participants at risk of AF. Preferences were elicited through ranking and rating medication preference factor statements, then selecting most and least preferred treatment options. Results Reduced stroke risk and lowest risk of an intracranial haemorrhage (ICH) had the highest median preference factor ranking of 2 (IQR, 1-3.5 for stroke reduction; 2-4 for ICH risk). Reducing stroke risk, availability of a lab test to assess drug effect, and availability of an antidote were the preference factors with the highest ratings. Apixaban was the most preferred treatment option (44% blinded to drug name, 37% unblinded) while 'No treatment' was the least preferred option (48% blinded, 52% unblinded). Conclusions Reducing stroke risk and limiting ICH risk were the most important medication factors to participants. High inter-participant preference variability suggests the importance of including the patient in decision-making when selecting AF stroke prophylaxis.
authors.affiliation: Department of Pharmacy, Island Health, 1952 Bay St, Victoria, BC, V8R 1J8, Canada.
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Edwards
authors.affiliation: Department of Pharmacy, Island Health, 1952 Bay St, Victoria, BC, V8R 1J8, Canada.|Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Westbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
authors.forename: Erica D
authors.initials: ED
authors.lastname: Greanya
authors.affiliation: Faculty of Pharmacy, University of Manitoba, 750 McDermot Ave, Winnipeg, MB, R3E 0T5, Canada.
authors.lastname: I Fan Kuo
authors.affiliation: Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Westbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
authors.forename: Peter S
authors.initials: PS
authors.lastname: Loewen
authors.affiliation: Department of Pharmacy, Island Health, 1952 Bay St, Victoria, BC, V8R 1J8, Canada. Celia.Culley@viha.ca.|Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Westbrook Mall, Vancouver, BC, V6T 1Z3, Canada. Celia.Culley@viha.ca.
authors.forename: Celia L
authors.initials: CL
authors.lastname: Culley
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000517:prevention & control / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000523:psychology*; D016037:Single-Blind Method; D020521:Stroke / Q000517:prevention & control / Q000523:psychology*
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Atrial fibrillation; Canada; Outpatients; Patient preference; Prevention; Shared decision making; Stroke