Preference-based antithrombotic therapy in atrial fibrillation: Implications for clinical decision making
Preference-based antithrombotic therapy in atrial fibrillation: Implications for clinical decision making
复制标题
DOI：
10.1177/0272989x05280558
复制
发表时间：
2005-09-01
影响因子：
3.6
通讯作者：
Laupacis, A
中科院分区：
文献类型：
--
作者：
Man-Son-Hing, M;Gage, BF;Laupacis, A
背景患者偏好和专家制定的关于治疗决策的临床实践指南可能不完全相同。作者将确定或模拟房颤患者治疗偏好的研究中的抗血栓治疗阈值与临床实践指南中的建议进行了比较。方法.方法包括MEDLINE检索、系统回顾和汇总，并对相关研究的原始数据进行再分析。结果确定了8项相关研究，包括890例患者。这些研究使用3种方法（决策分析、概率权衡和决策辅助）来确定或模拟患者偏好。所有方法都强调，华法林优于阿司匹林的阈值是高度可变的。在8项研究中的6项中，患者偏好表明，与指南的建议相比，更少的患者会服用华法林。一般来说，在阿司匹林的卒中发生率为1%时，一半的参与者更喜欢华法林，在阿司匹林的卒中发生率为2%时，三分之二的参与者更喜欢华法林。在3项研究中，华法林必须提供每年至少0.9%至3.0%的卒中风险绝对降低，患者才愿意服用，相当于阿司匹林的卒中率为2%至6%。结论.对于房颤患者，临床实践指南中的治疗建议通常与患者偏好不同，其个体偏好存在显著异质性。由于患者的偏好对临床决策过程有重大影响，因此应将其重要性纳入临床实践指南。执业医师需要平衡患者的偏好与临床实践指南的治疗建议。
Background. Patient preferences and expert-generated clinical practice guidelines regarding treatment decisions may not be identical. The authors compared the thresholds for antithrombotic treatment from studies that determined or modeled the treatment preferences of patients with atrial fibrillation with recommendations from clinical practice guidelines. Methods. Methods included MEDLINE identification, systematic review, and pooling with some reanalysis of primary data from relevant studies. Results. Eight pertinent studies, including 890 patients, were identified. These studies used 3 methods (decision analysis, probability tradeoff, and decision aids) to determine or model patient preferences. All methods highlighted that the threshold above which warfarin was preferred over aspirin was highly variable. In 6 of 8 studies, patient preferences indicated that fewer patients would take warfarin compared to the recommendations of the guidelines. In general, at a stroke rate of 1% with aspirin, half of the participants would prefer warfarin, and at a rate of 2% with aspirin, two thirds would prefer warfarin. In 3 studies, warfarin must provide at least a 0.9% to 3.0% per year absolute reduction in stroke risk for patients to be willing to take it, corresponding to a stroke rate of 2% to 6% on aspirin. Conclusions. For patients with atrial fibrillation, treatment recommendations from clinical practice guidelines often differ from patient preferences, with substantial heterogeneity in their individual preferences. Since patient preferences con have a substantial impact on the clinical decision-making process, acknowledgment of their importance should be incorporated into clinical practice guidelines. Practicing physicians need to balance the patient preferences with the treatment recommendations from clinical practice guidelines.