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Shared Decision-Making for Patients Hospitalized with Acute Myocardial Infarction: A Randomized Trial

Authors
  • Branda, Megan E
  • Kunneman, Marleen
  • Meza-Contreras, Alejandra I
  • Shah, Nilay D
  • Hess, Erik P
  • LeBlanc, Annie
  • Linderbaum, Jane A
  • Nelson, Danika M
  • Mc Donah, Margaret R
  • Sanvick, Carrie
  • Van Houten, Holly K
  • Coylewright, Megan
  • Dick, Sara R
  • Ting, Henry H
  • Montori, Victor M
Type
Published Article
Journal
Patient Preference and Adherence
Publisher
Dove Medical Press
Publication Date
Jun 01, 2022
Volume
16
Pages
1395–1404
Identifiers
DOI: 10.2147/PPA.S363528
PMID: 35673524
PMCID: PMC9167591
Source
PubMed Central
Keywords
Disciplines
  • Clinical Trial Report
License
Unknown

Abstract

Objective Adherence to guideline-recommended medications after acute myocardial infarction (AMI) is suboptimal. Patient fidelity to treatment regimens may be related to their knowledge of the risk of death following AMI, the pros and cons of medications, and to their involvement in treatment decisions. Shared decision-making may improve both patients’ knowledge and involvement in treatment decisions. Methods In a pilot trial, patients hospitalized with AMI were randomized to the use of the AMI Choice conversation tool or to usual care. AMI Choice includes a pictogram of the patient’s estimated risk of mortality at 6 months with and without guideline-recommended medications, ie, aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors. Primary outcomes were patient knowledge and conflict with the decision made assessed via post-encounter surveys. Secondary outcomes were patient involvement in the decision-making process (observer-based OPTION12 scale) and 6-month medication adherence. Results Patient knowledge of the expected survival benefit from taking medications was significantly higher (62% vs 16%, p <0.0001) in the AMI Choice group (n = 53) compared to the usual care group (n = 53). Both groups reported similarly low levels of conflict with the decision to start the medications (13 (SD 24.2) vs 16 (SD 22) out of 100; p =0.16). The extent to which clinicians in the AMI Choice group involved their patients in the decision-making process was high (OPTION12 score 53 out of 100, SD 12). Medication adherence at 6-months was relatively high in both groups and not different between groups. Conclusion The AMI Choice conversation tool improved patients’ knowledge of their estimated risk of short-term mortality after an AMI and the pros and cons of treatments to reduce this risk. The effect on patient fidelity to recommended medications of using this SDM tool and of SDM in general should be tested in larger trials enrolling patients at high risk for nonadherence. Trial Registration Number NCT00888537.

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