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Health Expect. 2015 Dec;18(6):2318-27. doi: 10.1111/hex.12201. Epub 2014 May 12.

Values and preferences for oral antithrombotic therapy in patients with atrial fibrillation: physician and patient perspectives.

Author information

1
Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau-CIBER of Epidemiology and Public Health (CIBERESP- IIB Sant Pau), Barcelona, Spain.
2
Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, MN, USA.
3
Unidad Docente de Medicina Familiar y Comunitaria, Hospital Donostia, Donostia, Spain.
4
Department of Clinical Epidemiology & Biostatistics, CLARITY Research Group, McMaster University Medical Centre 2C9, Hamilton, ON, Canada.
5
Centro de Salud de Beraun, Errenteria, San Sebastián, Spain.
6
SAP Litoral de Barcelona, Barcelona, Spain.
7
Unitat d'Hemostàsia i Trombosi, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
8
Unidad Formadora de Medicina Familiar y Comunitaria de A Coruña, Coruña, Spain.
9
Institut Català de la Salut, Barcelona, Spain.
10
Hospital Clínic, Barcelona, Spain.

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.

KEYWORDS:

anticoagulation; antithrombotic treatment; decision making; preferences; values

PMID:
24813058
PMCID:
PMC5810657
DOI:
10.1111/hex.12201
[Indexed for MEDLINE]
Free PMC Article

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