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Patient Education Strategies to Improve Risk of Stroke in Patients with Atrial Fibrillation

  • Arrhythmias (J. Bunch, Section Editor)
  • Published:
Current Cardiovascular Risk Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Patient education strategies are shown to reduce stroke risk in patients with atrial fibrillation (AF). We describe the most recent evidence-based treatments to reduce stroke risk and outline challenges that exist in empowering patients to be active participants in decision-making. The shared decision-making (SDM) panorama is highlighted due to its benefits, including increased patient participation in decision-making, patient and clinician satisfaction, and improved outcomes.

Recent Findings

Oral anticoagulation remains the preferred therapy for stroke prevention in AF. Several barriers to stroke risk reduction persist, including both upstream and downstream barriers on the provider and patient front. Appropriate patient education approaches consider health literacy levels, quality of education materials, and SDM concepts. Many distinct approaches to mitigating these barriers exist, but much remains to be done. To overcome the barriers to patient education, providers must consider social determinants of health including access to care, cultural and language barriers, and socioeconomic status. Each of these factors will ultimately interfere with the success of the educational interventions.

Summary

The current best practice for educating and engaging patients with AF regarding stroke prevention strategies is patient-centered and informed by SDM values. As AF could often be asymptomatic, patients are less likely to adhere to treatment if they do not understand the rationale and the long-term balance of potential benefits and harms. Patient education and engagement tools can assist health care providers when conveying this important message, in a culturally appropriate and adjusted way according to health literacy levels.

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Notes

  1. By the time of publication of this manuscript, the Stanford AFib Guide clinical trial had its results published [67]. The tool is now freely available on afibguide.com.

Abbreviations

AF:

Atrial fibrillation

LAAO:

Left atrial appendage occlusion

LEP:

Limited English proficiency

NOACs:

Non-vitamin K oral anticoagulants

OAC:

Oral anticoagulation

SDM:

Shared decision-making

References

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Authors and Affiliations

  1. Psychiatry Department, Yale University, New Haven, CT, USA

    Julio C. Nunes

  2. Stanford University School of Medicine, Stanford University, Stanford, CA, USA

    Shayena Shah

  3. Department of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, H2146, Stanford, CA, 94305, USA

    Muhammad Fazal, Paul J. Wang & Tina Baykaner

  4. Department of Internal Medicine, Stanford University, Stanford, CA, USA

    Sofia Elena Gomez & Chen Wei

  5. Prevention Research Center, Stanford University, Stanford, CA, USA

    Randall S. Stafford

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  1. Julio C. Nunes
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  2. Shayena Shah
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  8. Tina Baykaner
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Contributions

Conceptualization: JCN, SS, PJW, RSS, TB

Data collection: JCN, SS, TB

Interpretation: JCN, SS, MF, SEG, TB, CW

Writing manuscript: JCN, SS, MF, SEG, PJW, RSS, TB, CW

Corresponding author

Correspondence to Tina Baykaner.

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Conflict of Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

JCN, SS: none. MF: none. SEG: none. CW: none. PJW: research grant from the American Heart Association. RSS: research grant from the American Heart Association, consulting for AgeBold. TB: research grant from NIH (K23 HL145017), advisory board for Medtronic, PaceMATE and BIOTRONIK.

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Nunes, J.C., Shah, S., Fazal, M. et al. Patient Education Strategies to Improve Risk of Stroke in Patients with Atrial Fibrillation. Curr Cardiovasc Risk Rep 16, 249–258 (2022). https://doi.org/10.1007/s12170-022-00709-8

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