Helping Patients with Atrial Fibrillation Make Treatment Decisions

The American Heart Association and PCORI are excited to announce a major step in a multiyear partnership to identify and fund cardiovascular health research that will make a difference in patients’ lives.

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The AHA-PCORI Decision-making and Choices to Inform Dialogue and Empower AFib Patients (DECIDE) Center will develop, adapt, and test decision aids to help people with atrial fibrillation (AFib) make better-informed treatment choices with their doctors, thanks to $5 million in funding jointly awarded by our two organizations. AHA and PCORI announced last week that the University of Utah would house the center and carry out the research in collaboration with the Mayo Clinic.

AHA estimates that as of 2010, more than 6 million Americans had AFib, an irregular heartbeat that can lead to stroke and other heart-related complications. Taking blood-thinning medication greatly reduces the risk of stroke associated with AFib, but, as with any drug, these treatments have risks. Shared decision making provides patients information on the benefits and harms associated with treatment options, and then engages patients in a decision-making process with their clinician that reflects their values. We’re very excited to be supporting a project on such a high-burden topic with great potential for improvement for patients.

Patients Helped Identify Priority Topics

In late 2015, AHA and PCORI first partnered on a project to identify questions about cardiovascular health and disease and that could be approached by clinical comparative effectiveness research (CER). We started by crowdsourcing questions and decisional dilemmas about heart disease from patients and their caregivers, to identify the most important ones that were also feasible for us to address.

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The response highlighted concerns among patients and other stakeholders about how best to treat and prevent stroke, particularly when associated with AFib. We know that blood-thinning medications, or anticoagulants, can prevent strokes related to AFib, but we also know that many patients aren’t prescribed anticoagulants or they aren’t taking them. There are also downsides to these blood thinners, including out-of-pocket costs; dietary restrictions; and, most importantly, increased bleeding risk. We wanted to fund a project that would figure out how to make sure patients, their family caregivers, and their doctors have the best information and tools to make treatment decisions based on their individual goals and priorities.

For the next phase of our collaboration, in 2017, AHA and PCORI requested research proposals about shared decision making in the treatment of AFib. Research has shown that when patients use decision aids to facilitate shared decision making, they gain knowledge and clarity about their values and preferences around their treatment decisions. Decision aids—nonbiased, informational tools—help patients and those who care for them better understand their treatment options.

Refining Shared Decision Making Tools’ Effectiveness

We announced the awardee—the University of Utah, working with the Mayo Clinic—this month. This DECIDE Center will develop, test, and deliver shared decision making tools for clinicians and patients to use together to determine which treatment options should provide the desired outcomes for each patient. But what does that actually entail?

Emphasizing Shared Decision Making in Cardiovascular Health Care

Researchers will survey existing decision aids for patients diagnosed with AFib. They will take content from the best options and adapt it to form two decision aids with the same information but varying delivery styles. One decision aid will be for patients to use before they visit their clinicians, and the other will be for patients and their clinicians to use together during an office visit. While both kinds of aids have been shown to improve aspects of shared decision making, no studies have yet compared the effectiveness of the two delivery types against one another for treating AFib.

In the next phase of the project, the research team will conduct a multisite randomized trial to compare the two types of decision aids.

The research team will score which approach does the best job at improving a patient’s knowledge about their options and clarity about their decision, as well as enhancing the communication between patient and clinician. Secondary outcomes will include patients’ use of blood thinners. An optimal shared decision making approach could improve outcomes of millions of patients.

The PCORI-AHA DECIDE Center is part of AHA’s larger AFib Strategically Focused Research Network. This network, composed of six research centers, establishes a mechanism to enhance the understanding of AFib and to develop more-effective ways to treat it and prevent risks such as stroke, ultimately improving patient outcomes.

AHA and PCORI are excited to be collaborating again to fund research that is central to both organizations’ missions, and more importantly, fills a critical research gap that will help millions of patients with AFib across the country.

Editor's note: At the time that this blog post was published, Diane E. Bild, MD, MPH served as associate director in the Clinical Effectiveness and Decision Science program.