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Brain & Heart Digital tools for stroke and bleeding risk in AF

in 2019 regarding the creation of the Mayo Clinic are warranted. Outcomes that could be examined in future
Anticoagulation Decision Aid, noting that results studies include patients’ adherence to anticoagulation,
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presented as a large graphic with minimal data points and patients’ understanding of their clinical profile and evidence-
numbers allowed physicians to elaborate on them during based recommendations, patients’ perception of the
clinic visits and thereby engage in shared decision-making. congruence of the output according to their personal values
It was positively received by patients and improved their and preferences, and provider and patients’ perception of the
understanding of the indication for anticoagulation, role of the digital tool in enhancing the clinical encounter.
without increasing the duration of the clinical encounter.
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To determine if adherence to anticoagulation was improved 9. Online resources for patient education
with the implementation of the Mayo Clinic Anticoagulation In addition to the digital tools for decision-making
Decision Aid, the SDM4AFIB investigators designed a described in Tables 3 and 4, there are several additional
randomized controlled trial; the only randomized trial online resources that deserve mention. These patient-
among all the featured digital tools. Patient encounters centered online resources are educational portals with
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were randomized to either shared decision-making tool written, illustrated, and video materials to enhance
use (SDM; 463 encounters) or no tool (usual care [UC]; patient understanding of both the risks and benefits of
459 encounters). The primary outcomes were primary anticoagulation in AF. They serve as decision aids for
adherence (adherence to prescribed anticoagulant at patients by summarizing information and engaging users to
10 months) and secondary adherence (determined as make an informed decision about a diagnosis of AF and the
times filling prescriptions or INR within therapeutic risks and benefits associated with available interventions.
range if patients were prescribed warfarin). No difference In contrast to the digital tools for decision-making
in primary or secondary adherence to anticoagulation previously described, these resources do not dynamically
between both groups was found; 78% in the SDM group generate different outputs based on a calculated risk score.
vs. 81% in the UC group filled their first prescription. 89
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The investigators also provided a resource page with their First is the Stanford Afib Guide. This tool is designed
research and approaches for further validating shared to enhance patient comprehension of AF through an
decision-making tools. 86 interactive, gamified, web-based interface that contains
both textual and video resources. It is aimed at patients
8.2. Studies associated with the GARFIELD-AF Risk who seek a deeper understanding of AF by mixing video
Calculator material with easy-to-understand graphics that serve as
questions to test understanding.
The GARFIELD-AF Risk Calculator is a digital tool that
allows interaction with the GARFIELD-AF predictive Second is the module on AF: Should I Take an
risk score specifically. The GARFIELD-AF score itself was Anticoagulant to Prevent Stroke? by the Ottawa Health
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previously validated in a large study against HAS-BLED Research Institute in collaboration with Healthwise. This
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and CHA DS -VASc, as described above. To date, the tool serves as a decision aid that presents information
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utility of the GARFIELD-AF digital tool in enhancing the on aspects of AF diagnosis and care to help patients
use of the GARFIELD-AF score has not been studied. understand their treatment options and the associated
risks and benefits. It features a dashboard guiding patients
8.3. Studies associated with the SPARCtool through six major steps organized into different tabs.
The creators of the SPARCtool published a white paper The first two steps introduce information about AF and
describing the development of the tool in 2003. In 2019, available medical treatments. Steps three and four provide
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a small observational pilot study enrolled 37 participants. space for patients to reflect on their thoughts regarding an
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The digital tool was effective in reducing decisional conflict, AF diagnosis, concerns about stroke risk, and confidence
eliciting patients’ values, increasing patient knowledge, in adhering to treatment options. Subsequently, both steps
and successfully showing individualized therapy options four and five allow patients to assess their readiness to
for patients to use. start treatment and their understanding of the presented
material, respectively. The output of these interactions is
8.4. Need for further validation studies presented as a summary in step six, which the patient can
The scarcity of literature on digital tool validation should keep for personal records or share with a physician.
not detract from its potential value in improving patient Third is the Atrial Fibrillation: Stroke Prevention
understanding and shared decision-making. Nonetheless, Decision Aid by the Colorado Program for Patient-
further efforts to evaluate the general applicability of these Centered Decisions. This aid presents information about
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digital tools, particularly those lacking supporting studies, the risks and benefits of interventions to prevent stroke

Volume 2 Issue 3 (2024) 16 doi: 10.36922/bh.3068