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Comparative Study
. 2001 May;174(5):311-5.
doi: 10.1136/ewjm.174.5.311.

Effects of patients' preferences on the treatment of atrial fibrillation: observational study of patient-based decision analysis

J Protheroe  1 , T Fahey, A A Montgomery, T J Peters
Affiliations
Comparative Study

Effects of patients' preferences on the treatment of atrial fibrillation: observational study of patient-based decision analysis

J Protheroe et al. West J Med. 2001 May.

Abstract

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.

Design: Observational study based on interviews with patients.

Setting: 8 general practices in Avon, England.

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

Main outcome measures: 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.

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Figures

Figure 1
Figure 1
Decision tree of health states resulting from having atrial fibrillation with utility values (median [interquartile range]) for each health state
Figure 2
Figure 2
Levels of disagreement between treatment preferences based on decision analysis and recommendation of treatment guidelines from a consensus conference and absolute risk
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