Need for Engagement in Stroke Prevention Shared Decision-Making in Older Adults with Atrial Fibrillation and Multimorbidity-Advances in Geriatric Medicine and Research-CSCIED科技核心评价数据库-手机版

Need for Engagement in Stroke Prevention Shared Decision-Making in Older Adults with Atrial Fibrillation and Multimorbidity

Need for Engagement in Stroke Prevention Shared Decision-Making in Older Adults with Atrial Fibrillation and Multimorbidity

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DOI	10.20900/agmr20250016
刊名	Advances in Geriatric Medicine and Research AGMR
年，卷(期)	2025, 7(3)
作者	Hawa O. Abu*,Jane S. Saczynski,Michelle Nabi,Annie Ferris,Mayra Tisminetzky,Jerry H. Gurwitz,Kathleen Mazor,Robert J. Goldberg,David Dosa,Alok Kapoor,Daniel Matlock,David D. McManus,
作者单位	Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01605, USA ; Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA 02115, USA ; Department of Medicine, UMass Chan Medical School, Worcester, MA 01655, USA ; Department of Neurology, UMass Chan Medical School, Worcester, MA 01655, USA ; Division of Health Systems Science, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA ; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA ; Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA ;
摘要	Aim: To assess the prevalence of older adults with AF and multimorbidity expressing a need for greater involvement in SDM for stroke prevention and associated patient characteristics. Methods: A prospective cohort study (2016–2018) enrolled patients aged 65 years and older with AF from clinics in MA and Georgia. Participants with one or more chronic conditions were included in this study. To assess patient preferences for greater engagement in SDM, participants on oral anticoagulants were asked at the one-year follow-up if they would like to be more involved in deciding to take an anticoagulant and which oral anticoagulant to use for stroke prevention. Multivariable logistic regression analysis was used to identify patient characteristics associated with preference for more SDM engagement. Results: Among participants (n = 532; mean age: 75 years; 48% women, 87% White), 41% had 1–4 chronic conditions, 40% had 5–7, and 19% had 8 or more. Approximately one-third expressed a preference for both engaging in SDM on anticoagulation initiation and choosing the type of anticoagulant for stroke prevention. After multivariable adjustment, participants who were younger (aged 65–74 years), women, non-White, had less than high school education, higher perceived burden from anticoagulation use, or had fewer comorbidities, were more likely to report the need for greater SDM engagement for stroke prevention. Conclusions: Clinicians should recognize the specific needs of older patients with AF and multimorbidity that seek greater involvement in SDM for stroke prevention. Providing tailored interventions can enhance stroke prevention decision-making in this vulnerable population.
Abstract	Aim: To assess the prevalence of older adults with AF and multimorbidity expressing a need for greater involvement in SDM for stroke prevention and associated patient characteristics. Methods: A prospective cohort study (2016–2018) enrolled patients aged 65 years and older with AF from clinics in MA and Georgia. Participants with one or more chronic conditions were included in this study. To assess patient preferences for greater engagement in SDM, participants on oral anticoagulants were asked at the one-year follow-up if they would like to be more involved in deciding to take an anticoagulant and which oral anticoagulant to use for stroke prevention. Multivariable logistic regression analysis was used to identify patient characteristics associated with preference for more SDM engagement. Results: Among participants (n = 532; mean age: 75 years; 48% women, 87% White), 41% had 1–4 chronic conditions, 40% had 5–7, and 19% had 8 or more. Approximately one-third expressed a preference for both engaging in SDM on anticoagulation initiation and choosing the type of anticoagulant for stroke prevention. After multivariable adjustment, participants who were younger (aged 65–74 years), women, non-White, had less than high school education, higher perceived burden from anticoagulation use, or had fewer comorbidities, were more likely to report the need for greater SDM engagement for stroke prevention. Conclusions: Clinicians should recognize the specific needs of older patients with AF and multimorbidity that seek greater involvement in SDM for stroke prevention. Providing tailored interventions can enhance stroke prevention decision-making in this vulnerable population.
关键词	atrial fibrillation; multimorbidity; stroke prevention; shared decision-making; older adults
KeyWord	atrial fibrillation; multimorbidity; stroke prevention; shared decision-making; older adults
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Hawa O. Abu*,Jane S. Saczynski,Michelle Nabi,Annie Ferris,Mayra Tisminetzky,Jerry H. Gurwitz,Kathleen Mazor,Robert J. Goldberg,David Dosa,Alok Kapoor,Daniel Matlock,David D. McManus. Need for Engagement in Stroke Prevention Shared Decision-Making in Older Adults with Atrial Fibrillation and Multimorbidity [J]. Advances in Geriatric Medicine and Research. 2025; 7; (3). - .

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