Values and preferences for oral antithrombotic therapy in patients with atrial fibrillation: physician and patient perspectives
Por:
Alonso-Coello, P, Montori, VM, Diaz, MG, Devereaux, PJ, Mas, G, Diez, AI, Sola, I, Roura, M, Souto, JC, Oliver, S, Ruiz, R, Coll-Vinent, B, Gich, I, Schunemann, HJ, Guyatt, G
Publicada:
1 dic 2015
Resumen:
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.
Filiaciones:
Alonso-Coello, P:
CIBER Epidemiol & Publ Hlth CIBERESP IIB St Pau, Biomed Res Inst St Pau, Iberoamer Cochrane Ctr, Barcelona 08025, Spain
Montori, VM:
Mayo Clin, Knowledge & Encounter Res Unit, Rochester, MN USA
Diaz, MG:
Hosp Donostia, Unidad Docente Med Familiar & Comunitaria, Donostia San Sebastian, Spain
Devereaux, PJ:
McMaster Univ, Med Ctr 2C9, CLARITY Res Grp, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada
Mas, G:
CIBER Epidemiol & Publ Hlth CIBERESP IIB St Pau, Biomed Res Inst St Pau, Iberoamer Cochrane Ctr, Barcelona 08025, Spain
Diez, AI:
Ctr Salud Beraun, San Sebastian, Spain
Sola, I:
CIBER Epidemiol & Publ Hlth CIBERESP IIB St Pau, Biomed Res Inst St Pau, Iberoamer Cochrane Ctr, Barcelona 08025, Spain
Roura, M:
SAP Litoral Barcelona, Barcelona, Spain
Souto, JC:
Hosp Santa Creu & Sant Pau, Unitat Hemostasia & Trombosi, Barcelona, Spain
Oliver, S:
Unidad Formadora Med Familiar & Comunitaria A Cor, Coruna, Spain
Ruiz, R:
Inst Catala Salut, Barcelona, Spain
Coll-Vinent, B:
Hosp Clin Barcelona, Barcelona, Spain
Gich, I:
CIBER Epidemiol & Publ Hlth CIBERESP IIB St Pau, Biomed Res Inst St Pau, Iberoamer Cochrane Ctr, Barcelona 08025, Spain
Schunemann, HJ:
McMaster Univ, Med Ctr 2C9, CLARITY Res Grp, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada
Guyatt, G:
McMaster Univ, Med Ctr 2C9, CLARITY Res Grp, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada
Bronze, Green Published
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