Abstract 4365500: Improved Shared Decision-Making on Stroke and Bleeding Risks in Atrial Fibrillation: A Mixed-Methods Study of a Tablet-Based Risk Visualization Tool

Abstract

Background: Oral anticoagulants (OACs) remain a cornerstone for preventing ischemic stroke in patients with atrial fibrillation (AF). However, patients often have limited understanding of the risks and benefits associated with OAC use, highlighting the need for improved shared decision-making (SDM) in clinical practice. Methods: We developed a tablet application that allows patients enter their own clinical data and instantly view their annual stroke and major-bleeding probabilities, calculated with the modified CHA2DS2-VASc and the DOAC scores. The project followed a convergent mixed-methods design. (1) Qualitative Phase: The first 24 consecutive outpatients with AF who were already receiving OACs (April–July 2024) took part in face-to-face, semi-structured interviews to identify unmet needs and refine the interface. (2) Quantitative Phase: After minor revisions, the finalized tool was tested by an additional 57 patients (August 2024–February 2025), giving a total of 81 survey respondents. All 81 participants completed pre- and post-use questionnaires (5-point Likert scales) that rated (i) physician-provided information, (ii) motivation to adhere to OACs, and (iii) the tool’s contribution to SDM. Results: Among the 81 questionnaire respondents (mean age: 69.8 years; female: 24.7%), 84% rated the quality of information provided by their physician as “excellent” or “good.” In contrast, 49% disagreed or strongly disagreed that they had previously received individualized estimates of stroke and bleeding risk during outpatient visits. Following the use of the tool, 73% reported increased motivation to continue OAC therapy, and 84% agreed or strongly agreed that the tool contributed to improved SDM. The interview subset further echoed these benefits (e.g. risk visualization enhanced motivation for OAC adherence), but also revealed two limitations: (i) difficulty interpreting some graphical elements and (ii) a desire for more personalized coaching on self-management. Conclusion: In this sequential mixed-methods study, a patient-entered, tablet-based risk-visualization tool strengthened motivation for OAC adherence and was perceived to enhance SDM. Future iterations should focus on clearer visual design and more individualized explanatory support to maximize clinical impact.