Feasibility of Implementing an Individualized, Evidence Based Stroke Prevention Counseling Program for Patients with Atrial Fibrillation

Objectives

The purpose of this study was to evaluate the feasibility and utility of teaching patients about atrial fibrillation and stroke prevention therapies using individualized, evidence-based information and a handheld computer based tool for risk and benefit estimation.

Setting

A Canadian teaching hospital.

Design

Qualifying patients with atrial fibrillation received information about atrial fibrillation and preventative therapies using qualitative, quantitative and graphical formats. Baseline risk of ischemic stroke and the magnitude of the risks and benefits of each therapeutic alternative were estimated at the bedside using a handheld computer-based tool. Assessments of decisional conflict, atrial fibrillation and stroke knowledge, medication knowledge, feasibility, and therapeutic preferences were performed after the counseling intervention.

Results

Fifty patients were screened and 5 were enrolled. The primary reasons for disqualification were cognitive impairment and length of stay <48 hours. After the counseling intervention, patients tended to prefer warfarin for stroke prophylaxis and there was a low level of decisional conflict. The intervention took the pharmacist around 30 minutes to perform. The handheld computer risk estimation tool was useful.

Conclusions

The counseling intervention was feasible although a small proportion of patients would qualify according to the criteria used. Those patients who received individualized, evidence-based counseling were knowledgeable about their condition and confident with their decisions regarding drug therapy. A handheld computer-based tool offers an efficient, user-friendly method of estimating an individual’s risk for stroke and the effects of preventative therapies in patients with atrial fibrillation.

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