The impact of patients' preferences on the treatment of atrial fibrillation: observational study of patient based decision analysis

Objective To investigate the impact of patients' preferences for the treatm ent of atrial fibrillation, by using individualised decision analysis combi ning probability and utility assessments into a decision tree. Design Observational study based on interviews with patients. Setting Eight general practices in Avon. Participants 260 randomly selected patients aged 70-85 years with atrial fi brillation. Main outcome measures Patients' treatment preferences regarding anticoagula tion treatment warfarin) after individualised decision analysis; comparison of these preferences with treatment guidelines on the basis of comorbidity and absolute risk and compared with current prescription. Results Of 195 eligible patients, 97 participated in decision making using decision analysis. Among these 97, the decision analysis indicated that 59 (61%; 95% 97, the decision analysis indicated that (61%; 95%, confidence in terval 50% to 71%) would prefer anticoagulation treatment-considerably fewe r than those who would be recommended treatment according to guidelines. Th ere was marked disagreement between the decision analysis and guideline rec ommendations (kappa = 0.25 or less). Of 38 patients whose decision analysis indicated a preference for anticoagulation, 17 (45%) were being prescribed warfarin; on the other hand, 28 (47%) of 59 patients were not being prescr ibed warfarin although the results of their decision analysis suggested the y wanted to be. Conclusions in the context of shared decision making, individualised decisi on analysis is valuable in a sizeable proportion of elderly patients with a trial fibrillation. Taking account of patients' preferences would lead to f ewer prescriptions for warfarin than under published guideline recommendati ons. Decision analysis as a shared decision making tool should be evaluated in a randomised controlled trial.