Shared decision-making in atrial fibrillation: navigating complex issues in partnership with the patient.
Shared decision-making in atrial fibrillation: navigating complex issues in partnership with the patient.
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DOI：
10.1007/s10840-018-0465-5
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发表时间：
2019-11
期刊：
影响因子：
--
通讯作者：
Ting HH
中科院分区：
文献类型：
--
作者：
Noseworthy PA;Brito JP;Kunneman M;Hargraves IG;Zeballos-Palacios C;Montori VM;Ting HH
心房颤动（AF）是卒中的重要危险因素。尽管抗凝治疗可以有效降低这种风险，但许多高危患者在常规治疗中并未进行抗凝治疗。此外，在接受抗凝治疗的患者中，多达50%的人在一年内停止治疗。这种治疗不足的部分原因可能是难以做出艰难的决定，是否要开始潜在的终身治疗，这可能会带来巨大的成本、潜在的风险和对日常生活的影响。为了应对这些挑战，最新的美国指南发布了一级建议，即使用共同决策（SDM）来个性化患者的抗血栓治疗。主要心血管组织对SDM的呼吁是为了通过促进决策来提高护理质量，这些决策反映了对个体患者中风和出血风险的最佳选择，以及他们的合并症和社会个人背景。SDM很容易适用于当前的心血管实践，但需要继续开展工作，以确定简短、循证和以患者为导向的工具是否能够支持周到、以患者为中心的决策，并最终提高适当治疗的启动率和依从性。
Atrial fibrillation (AF) is an important risk factor for stroke. Although anticoagulation is effective in mitigating this risk, many high-risk patients are not anticoagulated in routine practice. Furthermore, as many as 50% of those who are prescribed an anticoagulant stop treatment within a year. This under treatment may be due, in part, to difficulty in navigating difficult decisions about initiating potentially lifelong therapy with significant costs, potential risks, and impact on daily life. To address these challenges, the most recent American guidelines issued a class I recommendation to use shared decision-making (SDM) to individualize patients’ antithrombotic care. The call by the major cardiovascular organizations for SDM is in an effort to improve quality of care by promoting decisions that reflect what is best for an individual patient based on their stroke and bleeding risks, as well as their comorbid conditions and socio-personal context. SDM is readily applicable to current cardiovascular practice, but ongoing work will be needed to determine whether brief, evidence-based, and patient-oriented tools are able to support thoughtful, patient-centered decision-making and, ultimately, improve the rates of appropriate treatment initiation and adherence.
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