Are we there yet? Shared Decision-Making Needs in Older Adults with Atrial Fibrillation and Multimorbidity

TL;DR

This study explores how older adults with atrial fibrillation and multiple chronic conditions want more involvement in decisions about stroke prevention treatments.

Contribution

The study identifies specific patient characteristics linked to a need for greater shared decision-making in stroke prevention for older adults with multimorbidity.

Findings

One-third of participants expressed a need for greater shared decision-making in anticoagulation decisions.

Younger age, non-White race, lower education, and higher perceived anticoagulation burden were associated with greater SDM needs.

Tailored interventions are needed to improve decision-making for this vulnerable patient group.

Abstract

Older adults with atrial fibrillation (AF) and multimorbidity face complex stroke prevention decisions. Identifying those with unmet Shared Decision-Making (SDM) needs can enhance patient-provider communication.

Examine the prevalence and characteristics of older adults with AF and multimorbidity expressing a need for greater SDM involvement for stroke prevention.

Patients aged 65 years and older with AF were enrolled in a prospective cohort study (2016-2018) from clinics in Massachusetts and Georgia. Participants with one or more chronic conditions were included. At one-year follow-up, participants on anticoagulation were asked about their preference for greater involvement in decision-making regarding the decision to use anticoagulation and the choice of anticoagulant. Affirmative responses indicated a need for greater SDM engagement. Multivariable logistic regression identified patient characteristics associated with preference for more SDM engagement.

Participants’ (n = 532) mean age was 75 years; 48% were women, and 87% were White. Overall, 41% had 1–4 chronic conditions, 40% had 5–7, and 19% had 8 or more. One-third expressed a need for greater SDM in both anticoagulation initiation and selection of anticoagulant. After multivariable adjustment, participants who were younger (aged 65–74 years), non-White, had lower education level, fewer comorbidities or a higher perceived burden from anticoagulation use, reported a need for greater SDM engagement for stroke prevention.

Clinicians need to recognize the specific needs of older patients with AF and multimorbidity that seek greater SDM involvement for stroke prevention. Providing tailored interventions can enhance the decision-making process for stroke prevention in this vulnerable population.