Slides for Best Science Medicine Course talk

Pearls and deeper thinking about stroke prevention for AF patients

https://bestsciencemedicine.com

May 4, 2019. Vancouver, BC.

Talk visuals

SPARCtool updated to version 9

version 9 release notes

www.sparctool.com

SPARCtool

• NEW annual risk of bleeding on NO THERAPY udpated to be patient-specific using sex and age from the “baseline cohort” (most applicable) in Selak et al. JAMA. 2018;319(24):2507–2520
• NEW Net Clinical Benefit estimates. Estimates strokes/systemic embolisms prevented per major bleed caused. These are time-independent (i.e. they apply to any unit of time). Values <1 mean more major bleeds are caused than SSE prevented. Values >1 mean more SSE are prevented than bleeds caused.
• NEW stroke and bleeding risks are now based on the linear predictor function of the respective prediction model derivation/validation study rather than on the actual risks in each stratum in those studies. This improves the reliability of the risk estimates by eliminating sporadic values (e.g. bleed risk less with HAS-BLED score 5 than score 4) and allows risk predictions for scores above those seen in actual studies (e.g. HAS-BLED >5) by extrapolating.
• [coming soon]“Other Attributes” of each antithrombotic therapy to support shared decision-making conversations

SPARCmobile

• [coming soon] update to v.9 as above
• [coming soon] “Other Attributes” of each antithrombotic therapy to support shared decision-making conversations

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.

Access the decision aid.

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