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Clinical Articles, News & Views

Patient preferences for arrhythmia management

A review of the evidence on patient values and preferences in the management of cardiac tachyarrhythmias was presented recently at EHRA Europace Cardiostim 2015, and published in EP Europace.1

The paper summarises current knowledge of patients’ experiences of living with various arrhythmias and their treatment preferences, and provides recommendations for health professionals. The authors make a number of consensus statements, including:

  • Education is an essential component of the management of cardiac arrhythmias to enable patients to understand their condition, the available treatments, disease trajectory, and possible outcomes.
  • All patients should receive individually tailored disease- and treatment-specific information from their healthcare team which is reiterated over time.
  • Patients’ preferences for treatment should be discussed, documented and incorporated into management decisions. Shared decision making should be the approach adopted.

Dr Deirdre Lane, task force chair, said: “Patients may have different priorities to doctors, particularly with regards to anticoagulation therapy to prevent stroke in atrial fibrillation. These patients are usually more concerned about stroke prevention than serious bleeding with research showing they are willing to accept 4.4 major bleeds to prevent one stroke.”

Dr Lane continued: “Patients may never be offered anticoagulation because of the doctor’s perception that the bleeding risk is too high. But patients live with the consequences of treatments so it’s reasonable that they should have some say. Patients should be told the pros and cons of the different treatment options so they can make an informed decision for themselves.”

“Anxiety plays a large role in cardiac arrhythmias because of the unpredictability of the symptoms and the outcomes. Some of the arrhythmias are life-threatening. Fear and anxiety can influence patients’ choice of treatment, their ability to process information and their likelihood of adhering to treatment. Healthcare professionals need to take this into account during consultations,” she added.

“Patients need information about their disease and treatment options in a format they can understand. That will enable them to weigh up the pros and cons and choose their preference for therapy. Shared decision making is advocated in healthcare but in practice it is still quite paternalistic. We also emphasise the need for good quality information and the document lists useful resources that healthcare professionals can point patients towards,” Dr Lane concluded.

References

1. Lane DA, Aguinaga L, Blomström-Lundqvist C, et al. Cardiac tachyarrhythmias and patient values and preferences for their management: An European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE) Europace 2015. http://dx.doi.org/10.1093/europace/euv233

Published on: July 30, 2015

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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