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Int J Stroke. 2017 Apr;12(3):222-228. doi: 10.1177/1747493016687579. Epub 2017 Jan 1.

Decision-making interventions to stop the global atrial fibrillation-related stroke tsunami.

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1 Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
2 Gait and Brain Lab, Parkwood Hospital and Lawson Health Research Institute, London, ON, Canada.
3 Department of Medicine, Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
4 Department of Epidemiology & Biostatistics, Schulich Interfaculty Program in Public Health, Western University, London, ON, Canada.
5 Institute of Cognitive and Translational Neuroscience (INCyT), INECO Foundation, Favaloro University, National Scientific and Technical Research Council, Buenos Aires, Argentina.
6 Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibanez, Santiago de Chile, Chile.
7 Centre of Excellence in Cognition and its Disorders, Australian Research Council (ARC), New South Wales, Australia.
8 Universidad Autónoma del Caribe, Barranquilla, Colombia.
9 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
10 University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, UK.
11 Department of Clinical Neurological Sciences, Department of Anatomy and Cell Biology, London Health Sciences Centre, Western University, London, ON, Canada.
12 London Stroke, Dementia & Heart Disease Laboratory, Western University, London, ON, Canada.


Atrial fibrillation affects 33.5 million people worldwide and its prevalence is expected to double by 2050 because of the aging population. Atrial fibrillation confers a 5-fold higher risk of ischemic stroke compared to sinus rhythm. We present our view of the role of shared medical decision-making to combat global underutilization of oral anticoagulation for stroke prevention in atrial fibrillation patients. Oral anticoagulation underuse is widespread as it is present within atrial fibrillation patients of all risk strata and in countries across all income levels. Reasons for oral anticoagulation underuse include but are probably not limited to poor risk stratification, over-interpretation of contraindications, and discordance between physician prescription preferences and actual administration. By comparing a catastrophic event to the consequences of atrial fibrillation related strokes, it may help physicians and patients understand the negative outcomes associated with oral anticoagulation under-utilization and the magnitude to which oral anticoagulations neutralize atrial fibrillation burden.


Visual aid; atrial fibrillation; epidemiology; framing; oral anticoagulation; stroke

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