TY - JOUR
T1 - Preference-based antithrombotic therapy in atrial fibrillation
T2 - Implications for clinical decision making
AU - Man-Son-Hing, Malcolm
AU - Gage, Brian F.
AU - Montgomery, Alan A.
AU - Howitt, Alistair
AU - Thomson, Richard
AU - Devereaux, P. J.
AU - Protheroe, Joanne
AU - Fahey, Tom
AU - Armstrong, David
AU - Laupacis, Andreas
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2005/9
Y1 - 2005/9
N2 - Background. Patient preferences and expert-generated clinical practice guidelines regarding treatment decisions may not be identical. The authors compared the thresholds for antithrombotic treatment from studies that determined or modeled the treatment preferences of patients with atrial fibrillation with recommendations from clinical practice guidelines. Methods. Methods included MEDLINE identification, systematic review, and pooling with some reanalysis of primary data from relevant studies. Results. Eight pertinent studies, including 890 patients, were identified. These studies used 3 methods (decision analysis, probability trade-off, and decision aids) to determine or model patient preferences. All methods highlighted that the threshold above which warfarin was preferred over aspirin was highly variable. In 6 of 8 studies, patient preferences indicated that fewer patients would take warfarin compared to the recommendations of the guidelines. In general, at a stroke rate of 1% with aspirin, half of the participants would prefer warfarin, and at a rate of 2% with aspirin, two thirds would prefer warfarin. In 3 studies, warfarin must provide at least a 0.9% to 3.0% per year absolute reduction in stroke risk for patients to be willing to take it, corresponding to a stroke rate of 2% to 6% on aspirin. Conclusions. For patients with atrial fibrillation, treatment recommendations from clinical practice guidelines often differ from patient preferences, with substantial heterogeneity in their individual preferences. Since patient preferences can have a substantial impact on the clinical decision-making process, acknowledgment of their importance should be incorporated into clinical practice guidelines. Practicing physicians need to balance the patient preferences with the treatment recommendations from clinical practice guidelines.
AB - Background. Patient preferences and expert-generated clinical practice guidelines regarding treatment decisions may not be identical. The authors compared the thresholds for antithrombotic treatment from studies that determined or modeled the treatment preferences of patients with atrial fibrillation with recommendations from clinical practice guidelines. Methods. Methods included MEDLINE identification, systematic review, and pooling with some reanalysis of primary data from relevant studies. Results. Eight pertinent studies, including 890 patients, were identified. These studies used 3 methods (decision analysis, probability trade-off, and decision aids) to determine or model patient preferences. All methods highlighted that the threshold above which warfarin was preferred over aspirin was highly variable. In 6 of 8 studies, patient preferences indicated that fewer patients would take warfarin compared to the recommendations of the guidelines. In general, at a stroke rate of 1% with aspirin, half of the participants would prefer warfarin, and at a rate of 2% with aspirin, two thirds would prefer warfarin. In 3 studies, warfarin must provide at least a 0.9% to 3.0% per year absolute reduction in stroke risk for patients to be willing to take it, corresponding to a stroke rate of 2% to 6% on aspirin. Conclusions. For patients with atrial fibrillation, treatment recommendations from clinical practice guidelines often differ from patient preferences, with substantial heterogeneity in their individual preferences. Since patient preferences can have a substantial impact on the clinical decision-making process, acknowledgment of their importance should be incorporated into clinical practice guidelines. Practicing physicians need to balance the patient preferences with the treatment recommendations from clinical practice guidelines.
KW - Atrial fibrillation
KW - Decision aids
KW - Decision analysis
KW - Patient preferences
KW - Probability tradeoff
UR - http://www.scopus.com/inward/record.url?scp=25644441822&partnerID=8YFLogxK
U2 - 10.1177/0272989X05280558
DO - 10.1177/0272989X05280558
M3 - Article
C2 - 16160210
AN - SCOPUS:25644441822
SN - 0272-989X
VL - 25
SP - 548
EP - 559
JO - Medical Decision Making
JF - Medical Decision Making
IS - 5
ER -