A patient decision aid to help atrial fibrillation patients understand their condition and engage with their care providers to make shared decisions

We made this patient decision aid (PDA) to help people with atrial fibrillation (AF) decide which treatment is best for them to prevent strokes. It provides a personalized summary of patients' preferences, preferred treatment, and detailed personalized information about the treatment that they can save, print, and take with them to conversations with caregivers. It takes 30-45 minutes to complete, depending on how quickly and how much of the information they read. For example, a patient with a lot of AF education may choose to skip the initial education information. 

We evaluated the effects of using the PDA on the knowledge, preferences and decision-making feelings of patients with AF. It was effective for reducing decisional conflict, increasing patient knowledge, eliciting patients’ values, and presenting therapy options that aligned with patients’ values and preferences. Using the PDA revealed that many patients have therapy preferences different from their currently prescribed treatment. Overall, patients found the PDA to be a practical and valuable tool to facilitate decision making about stroke prevention therapy for AF.

For a copy of the full report, send me an email or find it on the journal's site.

To access the decision aid [click here]. 

SPARCtool updated to version 8.2

version 8.2 release notes (Sept 2017)

www.sparctool.com 

SPARCtool

• Removed the US-specific edoxaban renal warnings as monographs differ on this worldwide. Replaced it with the same renal function warning as other NOACs, which is consistent with all edoxaban monographs.
• Added “Text for EMR” box for be cut-and-paste into EMR. Thank you, Mark McConnell, for this suggestion.

SPARCmobile

• Removed the US-specific edoxaban renal warnings as monographs differ on this worldwide. Replaced it with the same renal function warning as other NOACs, which is consistent with all edoxaban monographs.
• added an estimate for “Patient’s annual risk of stroke or TIA with no therapy if they did NOT have AF (for comparison):” based on Mitchell LB, Southern DA, Galbraith D, et al. Prediction of stroke or TIA in patients without atrial fibrillation using CHADS2 and CHA2DS2-VASc scores. Heart. 2014;100(19):1524–1530. doi:10.1136/heartjnl–2013–305303. CHA2DS2-VASc preducts stroke in non-AF patients simiarly well to AF patients. The risk estimates are much lower for non-AF patients, of course. This is added to SPARCtool based on feedback that it is valuable for patients to see how much higher their stroke risk is because of AF vs. without it.

Bleeding - The Long & Short of It - Best Science Medicine Course 2017

Handout

Know Your Birth Control Rights

Updated! 

SPARCtool Updated

version 6.21 release notes

SPARCmobile

• updated the disclaimer
• fixed truncated renal dysfunction warning for new OACs on iPhone and increased visibility of warnings.
• changed text of the warnings to “RENAL FUNCTION WARNING: Consult product monograph.” - dosage adjustment thresholds and stragtegies are evolving, so no specific advice is offered in the SPARCtool.
• lightened most of the fill colors
• updated dabigatran 150mg thromboembolism risk with updated RE-LY data (updated RR 0.66 −-> 0.65, RRR vs. warfarin from 78% to 79%) [Connolly SJ, Ezekowitz MD, Yusuf S, Reilly PA, Wallentin L. Newly Identified Events in the RE-LY Trial. N Engl J Med 2010;363:1875–6.]
• corrected major bleeding risk of ASA+clopidogrel to be the same as warfarin based on ACTIVE-W.
• added tabular view of the risks

SPARCtool

• updated the disclaimer
• changed text of the warnings to "WARNING: may be contraindicated or require dosage reduction depending on degree of renal dysfunction. Consult your country's monograph."
• dosage adjustment thresholds and stragtegies are evolving, so no specific advice is offered in the SPARCtool.
• lightened most of the fill colors
• updated dabigatran 150mg thromboembolism risk with updated RE-LY data (updated RR 0.66 −-> 0.65, RRR vs. warfarin from 78% to 79%) [Connolly SJ, Ezekowitz MD, Yusuf S, Reilly PA, Wallentin L. Newly Identified Events in the RE-LY Trial. N Engl J Med 2010;363:1875–6.]
• corrected major bleeding risk of ASA+clopidogrel to be the same as warfarin based on ACTIVE-W.
• added tabular view of the risks
• added graphical representation of the risks (requires Adobe Flash to view)