Mehawej Jordy, Saczynski Jane, Abu Hawa O, Gagnier Marc, Bamgbade Benita A, Lessard Darleen, Trymbulak Katherine, Saleeba Connor, Kiefe Catarina I, Goldberg Robert J, McManus David D
Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
Department of Pharmacy and Health Systems Sciences, Northeastern University, Boston, MA, USA.
Can Geriatr J. 2021 Sep 1;24(3):174-183. doi: 10.5770/cgj.24.475. eCollection 2021 Sep.
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).
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.
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.
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.
探讨心房颤动（AF）患者参与预防中风的共同决策（SDM）的程度及相关因素。
我们使用了老年元素-心房颤动系统评估研究的数据，该研究纳入了年龄较大（≥65岁）且CHA2DS2-VASc≥2的AF患者。参与者通过回答是否积极参与选择服用口服抗凝剂（OAC）来治疗其病情来报告参与SDM的情况。采用多因素逻辑回归分析来评估社会人口学、临床、老年医学和心理社会因素与患者参与SDM之间的关联。
共研究了807名正在服用OAC的参与者（平均年龄75岁；48%为女性）。其中，61%参与了SDM。年龄较大的参与者（≥80岁）和认知受损者参与SDM的可能性较小，而那些对其AF相关中风风险非常了解的参与者比相应的对照组更有可能参与SDM。
相当一部分老年AF患者未参与预防中风的SDM，年龄较大的患者和认知受损者参与的可能性较小。临床医生应识别出不太可能参与SDM的患者，促进患者参与，并加强医患沟通，这可能会改善患者的长期预后。
