OBJECTIVE: Shared decision making (SDM) tools can help implement guideline recommendations for patients with atrial fibrillation (AF) considering stroke prevention strategies. We sought to characterize all available SDM tools for this purpose and examine their quality and clinical impact. METHODS: We searched through multiple bibliographic databases, social media, and an SDM tool repository from inception to May 2020 and contacted authors of identified SDM tools. Eligible tools had to offer information about warfarin and ≥1 direct oral anticoagulant. We extracted tool characteristics, assessed their adherence to the International Patient Decision Aids Standards, and obtained information about their efficacy in promoting SDM. RESULTS: We found 14 SDM tools. Most tools provided up-to-date information about the options, but very few included practical considerations (e.g., out-of-pocket cost). Five of these SDM tools, all used by patients prior to the encounter, were tested in trials at high risk of bias and were found to produce small improvements in patient knowledge and reductions in decisional conflict. CONCLUSION: Several SDM tools for stroke prevention in AF are available, but whether they promote high-quality SDM is yet to be known. The implementation of guidelines for SDM in this context requires user-centered development and evaluation of SDM tools that can effectively promote high-quality SDM and improve stroke prevention in patients with AF.

Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA

Department of Library Public Services Mayo Clinic Rochester MN USA

Department of Population Health Sciences University of Utah Salt Lake City UT USA

Department of Psychiatry and Psychology Mayo Clinic Rochester MN USA

General Medicine Charles University Prague Medical Faculty of Hradec Králové Hradec Kralove Czech Republic

Knowledge and Evaluation Research Unit Department of Medicine Mayo Clinic Rochester MN USA

Plataforma INVEST Medicina UANL KER Unit Mayo Clinic School of Medicine Universidad Autonoma de Nuevo Leon Monterrey Nuevo Leon Mexico

Salt Lake City VA Informatics Decision Enhancement and Analytic Sciences Center for Innovation

School of Medicine Universidad Peruana Cayetano Heredia Lima Peru

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