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

circle Objective To investigate the effect of patients' preferences in the treatment of atrial fibrillation by using individualized decision analysis in which probability and utility assessments are combined into a decision t ree. circle Design Observational study based on interviews with patients. c ircle Setting 8 general practices in Avon, England. circle Participants 260 randomly selected patients aged 70 to 85 years with atrial fibrillation. c ircle Main outcome measures Patients' treatment preferences regarding antic oagulation treatment (warfarin sodium) after individualized decision analys is; comparison of these preferences with treatment guidelines on the basis of comorbidity and absolute risk and compared with current prescription. ci rcle Results Of 135 eligible patients, 97 participated in decision making u sing decision analysis. Among these 97, the decision analysis indicated tha t 59 (61%; 95% confidence interval, 50%-71%) would prefer anticoagulation t reatment, considerably fewer than those who would be recommended treatment according to guidelines. There was whose decision analysis indicated a pref erence for anticoagulation, 17 (45%) were being prescribed warfarin; on the other hand, 28 (47%) of 59 patients were not being prescribed warfarin, al though the results of their decision analysis suggested they wanted to be. circle Conclusions In the context of shared decision making, individualized decision analysis is valuable in a sizable proportion of elderly patients with atrial fibrillation. Taking account of patients' preferences would lea d to fewer prescriptions for warfarin man under published recommendations. Decision analysis as a shared decision-making tool should be evaluated in a randomized controlled trial.