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In Reply: I appreciate Dr. Henning’s letter in response to my editorial.1 Indeed, Dr. Eckman’s Atrial Fibrillation Decision Support Tool (AFDST) is useful for determining quality-adjusted life expectancy on or off anticoagulation, and could possibly help with shared decision-making in regard to anticoagulation.2–4
However, the AFDST does not incorporate personal preferences regarding anticoagulant or medication use in general. Many older adults are on too many medications (ie, polypharmacy) and wish to reduce their overall pill count.
A number of potential barriers to shared decision-making regarding medication use have been identified, including poor physician communication skills, the growing number of available medications, multiple prescribers for the same patient, lack of trust in the prescribing physician, and patients feeling that their preferences are not valued or important.5 Until communication and acceptance between prescribers and patients regarding possible medication choices improves, shared decision-making for medication use in general and anticoagulant use in particular will be an unfulfilled ideal.
- Suh TT. Whether to anticoagulate: toward a more reasoned approach. Cleve Clin J Med 2017; 84:41–42.
- Eckman MH, Lip GYH, Wise RE, et al. Impact of an atrial fibrillation decision support tool on thromboprophylaxis for atrial fibrillation. Am Heart J 2016; 176:17–27.
- Eckman MH, Wise RE, Speer B, et al. Integrating real-time clinical information to provide estimates of net clinical benefit antithrombotic therapy for patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes 2014; 7:680–686.
- Eckman MH, Lip TYH, Wise RE, et al. Using an atrial fibrillation decision support tool for thromboprophylaxis in atrial fibrillation: effect of sex and age. J Am Geriatr Soc 2016; 64:1054–1060.
- Belcher VN, Fried TR, Agostini JV, Tinetti ME. Views of older adults on patient participation in medication-related decision making. J Gen Intern Med 2006; 21:298–303.
In Reply: I appreciate Dr. Henning’s letter in response to my editorial.1 Indeed, Dr. Eckman’s Atrial Fibrillation Decision Support Tool (AFDST) is useful for determining quality-adjusted life expectancy on or off anticoagulation, and could possibly help with shared decision-making in regard to anticoagulation.2–4
However, the AFDST does not incorporate personal preferences regarding anticoagulant or medication use in general. Many older adults are on too many medications (ie, polypharmacy) and wish to reduce their overall pill count.
A number of potential barriers to shared decision-making regarding medication use have been identified, including poor physician communication skills, the growing number of available medications, multiple prescribers for the same patient, lack of trust in the prescribing physician, and patients feeling that their preferences are not valued or important.5 Until communication and acceptance between prescribers and patients regarding possible medication choices improves, shared decision-making for medication use in general and anticoagulant use in particular will be an unfulfilled ideal.
In Reply: I appreciate Dr. Henning’s letter in response to my editorial.1 Indeed, Dr. Eckman’s Atrial Fibrillation Decision Support Tool (AFDST) is useful for determining quality-adjusted life expectancy on or off anticoagulation, and could possibly help with shared decision-making in regard to anticoagulation.2–4
However, the AFDST does not incorporate personal preferences regarding anticoagulant or medication use in general. Many older adults are on too many medications (ie, polypharmacy) and wish to reduce their overall pill count.
A number of potential barriers to shared decision-making regarding medication use have been identified, including poor physician communication skills, the growing number of available medications, multiple prescribers for the same patient, lack of trust in the prescribing physician, and patients feeling that their preferences are not valued or important.5 Until communication and acceptance between prescribers and patients regarding possible medication choices improves, shared decision-making for medication use in general and anticoagulant use in particular will be an unfulfilled ideal.
- Suh TT. Whether to anticoagulate: toward a more reasoned approach. Cleve Clin J Med 2017; 84:41–42.
- Eckman MH, Lip GYH, Wise RE, et al. Impact of an atrial fibrillation decision support tool on thromboprophylaxis for atrial fibrillation. Am Heart J 2016; 176:17–27.
- Eckman MH, Wise RE, Speer B, et al. Integrating real-time clinical information to provide estimates of net clinical benefit antithrombotic therapy for patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes 2014; 7:680–686.
- Eckman MH, Lip TYH, Wise RE, et al. Using an atrial fibrillation decision support tool for thromboprophylaxis in atrial fibrillation: effect of sex and age. J Am Geriatr Soc 2016; 64:1054–1060.
- Belcher VN, Fried TR, Agostini JV, Tinetti ME. Views of older adults on patient participation in medication-related decision making. J Gen Intern Med 2006; 21:298–303.
- Suh TT. Whether to anticoagulate: toward a more reasoned approach. Cleve Clin J Med 2017; 84:41–42.
- Eckman MH, Lip GYH, Wise RE, et al. Impact of an atrial fibrillation decision support tool on thromboprophylaxis for atrial fibrillation. Am Heart J 2016; 176:17–27.
- Eckman MH, Wise RE, Speer B, et al. Integrating real-time clinical information to provide estimates of net clinical benefit antithrombotic therapy for patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes 2014; 7:680–686.
- Eckman MH, Lip TYH, Wise RE, et al. Using an atrial fibrillation decision support tool for thromboprophylaxis in atrial fibrillation: effect of sex and age. J Am Geriatr Soc 2016; 64:1054–1060.
- Belcher VN, Fried TR, Agostini JV, Tinetti ME. Views of older adults on patient participation in medication-related decision making. J Gen Intern Med 2006; 21:298–303.