A randomized trial to assess the impact of an antithrombotic decision aid in patients with nonvalvular atrial fibrillation: The DAAFI trial protocol [ISRCTN14429643]

被引：9
作者：
McAlister F.A. [1 ]
Man-Son-Hing M. [2 ]
Straus S.E. [3 ]
Ghali W.A. [4 ]
Gibson P. [4 ]
Anderson D. [5 ]
Cox J. [5 ]
Fradette M. [6 ]
Sackett D.
Teo K.
Laupacis A.
Priest P.
Hervas-Malou M.
Blitz S.
Larson B.
Jessup-Yabsley A.
Biggs J.
Bell N.
Bungard I.
Marquez C.
Quinton S.
McNeil A.
Lye T.
Auer J.
Bacskai S.
Beaulieau C.
Berlie M.
Biggs E.
Boag P.
Bowen D.
Brown E.
Brisebois J.
Buczek M.
Bushforth R.
Charania H.
Cregan T.
D'Amico C.
Dechesne C.
Dy H.
Edirisinghe M.
Elkin E.
Faloon T.
Finestone D.
Guy D.
Hans D.
Honsl E.
Hughes O.
Jaffer S.
John R.
Jones K.
机构：
[1] Div. of General Internal Medicine, University of Alberta, Edmonton, Alta.
[2] E. Bruyere Res./Geriat. Medicine, University of Ottawa, Ottawa, Ont.
[3] Div. of Geriatric/Gen. Internal Med., University of Toronto, Toronto, Ont.
[4] Div. of General Internal Medicine, University of Calgary, Calgary, Alta.
[5] Department of Medicine, Dalhousie University/Capital Health, Halifax, NS
[6] Epidemiol. Coordinating/Res. Center, University of Alberta, Edmonton, Alta.
来源：
BMC Cardiovascular Disorders | / 4卷 / 1期
关键词：
Warfarin; Family Physician; Antithrombotic Therapy; Decisional Conflict; Nonvalvular Atrial Fibrillation;
D O I：
10.1186/1471-2261-4-5
中图分类号：
学科分类号：
摘要：
Background: Decision aids are often advocated as a means to assist patient and health care provider decision making when faced with complicated treatment or screening decisions. Despite an exponential growth in the availability of decision aids in recent years, their impact on long-term treatment decisions and patient adherence is uncertain due to a paucity of rigorous studies. The choice of antithrombotic therapy for nonvalvular atrial fibrillation (NVAF) is one condition for which a trade-off exists between the potential risks and benefits of competing therapies, and the need to involve patients in decision making has been clearly identified. This study will evaluate whether an evidence-based patient decision aid for patients with NVAF can improve the appropriateness of antithrombotic therapy use by patients and their family physicians. Design: A multi-center, two-armed cluster randomized trial based in community family practices in which patients with NVAF will be randomized to decision aid or usual care. Patients will receive one of four decision aids depending on their baseline stroke risk. The primary outcome is the provision of "appropriate antithrombotic therapy" at 3 months to study participants (appropriateness defined as per the 2001 American College of Chest Physicians recommendations for NVAF). In addition, the impact of this decision aid on patient knowledge, decisional conflict, well-being, and adherence will be assessed after 3 months, 6 months, and 12 months. © 2004 McAlister et al; licensee BioMed Central Ltd.
引用
收藏
页数：9
相关论文
共 41 条
[1]  
Feinberg W.M., Blackshear J.L., Laupacis A., Kronmal R., Hart R.G., Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications, Arch. Intern. Med., 155, pp. 469-473, (1995)
[2]  
Sudlow M., Thomson R., Thwaites B., Rodgers H., Kenny R.A., Prevalence of atrial fibrillation and eligibility for anticoagulants in the community, Lancet, 352, pp. 1167-1171, (1998)
[3]  
Psaty B.M., Manolio T.A., Kuller L.H., Kronmal R.A., Kuller L.H., Cushman M., Fried L.P., White R., Furberg C.D., Rautaharju P.M., Incidence of and risk factors for atrial fibrillation in older adults, Circulation, 96, pp. 2455-2461, (1997)
[4]  
Wolf P.A., Abbott R.D., Kannel W.B., Atrial fibrillation: A major contributor to stroke in the elderly. The Framingham Study, Arch. Intern. Med., 147, pp. 1561-1564, (1987)
[5]  
Albers G.W., Dalen J.E., Laupacis A., Manning W.J., Petersen P., Singer D.E., Antithrombotic therapy in atrial fibrillation, Chest, 119, (2001)
[6]  
Hart R.G., Benavente O., McBride R., Pearce L.A., Antithrombotic therapy to prevent stroke in patients with atrial fibrillation: A meta-analysis, Annals of Internal Medicine, 131, pp. 492-501, (1999)
[7]  
van Walraven C., Hart R.G., Singer D.E., Laupacis A., Connolly S., Petersen P., Koudstaal P.R., Chang Y., Hellemons B., Oral anticoagulants vs aspirin in nonvalvular atrial fibrillation: An individual patient meta-analysis, JAMA, 288, pp. 2441-2448, (2002)
[8]  
Caro J.J., Flegel K.M., Orejuela M.E., Kelley H.E., Speckman J.L., Migliaccio-Walle K., Anticoagulant prophylaxis against stroke in atrial fibrillation: Effectiveness in actual practice, C. M. A. J., 161, 5, pp. 493-497, (1999)
[9]  
Frost L., Johnsen S.P., Pedersen L., Toft E., Husted S., Sorensen H.T., Atrial fibrillation or flutter and stroke: A Danish population-based study of the effectiveness of oral anticoagulation in clinical practice, J. Intern. Med., 252, 1, pp. 64-69, (2002)
[10]  
Gottlieb L.K., Salem-Schatz S., Anticoagulation in atrial fibrillation. Does efficacy in clinical trials translate into effectiveness in practice?, Arch. Intern. Med., 154, 17, pp. 1945-1953, (1994)
12345