ENGAGEMENT IN STROKE PREVENTION SHARED DECISION MAKING IN OLDER ADULTS WITH ATRIAL FIBRILLATION AND MULTIMORBIDITY - Background, Objective, Methods, Results, Conclusions

Sep 28, 2026

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Study examines how older adults with atrial fibrillation (AF) and multimorbidity engage in shared decision making (SDM) for stroke prevention. A prospective cohort (2016–2018) enrolled adults aged ≥65 from clinics in Massachusetts and Georgia. One-year follow-up assessed involvement in choosing oral anticoagulation and selecting an anticoagulant. Only 33% were fully engaged, while 35% did not actively participate. Non-engaged participants were older, more often non-White, with lower education, cognitive impairment, frailty, poorer self-rated health, greater daily activity dependency, higher comorbidity burden, and lower perceived benefit from anticoagulation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages1

Reading Time3 min

AccessFree to download

Background

Objective

Methods

Results

Conclusions

Innovation in Aging, 2025, Vol. 9, No. S2 989 with AF and multimorbidity, healthcare providers should be aware of vulnerable populations that are at risk of being excluded from proper engagement in SDM for stroke prevention to ensure a more tailored approach to providing holistic and patient-centered care for improved outcomes. Abstract citation ID: igaf122.3337 ENGAGEMENT IN STROKE PREVENTION SHARED DECISION MAKING IN OLDER ADULTS WITH ATRIAL FIBRILLATION AND MULTIMORBIDITY Hawa Abu1, Jane Saczynski2, Jerry Gurwitz1, Kathleen Mazor1, Robert Goldberg1, David Dosa1, Alok Kapoor1, and David McManus1, 1. University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States, 2. Northeastern University, Boston, Massachusetts, United States Background: Older adults with atrial fibrillation (AF) and multimorbidity are posed with stroke prevention decisional conflicts. Understanding the factors that predict engagement in shared decision making (SDM) can enhance patient-centered care. Objective: To examine the extent of engagement in SDMon stroke prevention among older adults with AF and multimorbidity. Methods: A prospective cohort study (2016-2018) enrolled patients aged ≥65 years with AF from clinics in Massachusetts and Georgia. Those with one or more chronic conditions were included in the present study. At one-year follow-up, participants on oral anticoagulation were asked about their involvement in both choosing to be on anticoagulation and selecting an anticoagulant. Engagement in SDM was categorized as fully engaged (affirmative to both questions), partially engaged (affirmative to one), or not engaged (non-affirmative to both) . Results: Among 808 participants (mean age 75 years, 48% women, 88% White), 33% were engaged in both aspects of SDM, 28% participated in anticoagulation initiation, 4% in selecting a specific anticoagulant, and 35% did not actively participate in either. Non-engaged patients were more likely to be older, non-White, have lower education levels, cognitive impairment, frailty, poor self-rated health, greater dependency in daily activities, higher comorbidity burden, and lower perceived benefit from anticoagulation. Conclusions: In managing older adults

FAQs

What population and clinical context does the study focus on?

Older adults with atrial fibrillation (AF) and multimorbidity who face decisional conflicts about stroke prevention and oral anticoagulation.

How was engagement in shared decision making (SDM) measured?

Participants were asked at one-year follow-up about involvement in choosing anticoagulation and selecting an anticoagulant. Engagement was categorized as fully engaged, partially engaged, or not engaged.

What proportion of participants were engaged in both SDM aspects?

33% were engaged in both aspects, 28% participated in anticoagulation initiation, 4% selected a specific anticoagulant, and 35% did not actively participate in either.

Which factors were more common among non-engaged patients?

Non-engaged patients were more likely to be older, non-White, less educated, and to have cognitive impairment, frailty, poor self-rated health, greater daily activity dependency, higher comorbidity burden, and lower perceived benefit from anticoagulation.

Sep 28, 2026

Uploaded by Aurelia