Post-MI Shared Decision-Making Tool Shows Promise in Pilot Study

The study covered in this summary was published in medRxiv.org as a preprint and has not yet been peer reviewed.

Key Takeaways

AMI Choice, a conversation tool studied for use in shared decision-making for care after an acute myocardial infarction (MI) was found to be effective in increasing patients’ knowledge of treatment decisions and allowed them more involvement in their care.
In comparison to usual care, AMI Choice did not increase adherence to medication at the 6-month post-MI follow up.

Why This Matters

Patients who are educated about their treatment and the potential risks of not taking their medications after an acute MI may seek more involvement in the decision-making process regarding their treatments.
A tool to increase the efficacy of shared decision-making could potentially improve patient adherence to medications and thereby reduce their cardiac mortality.

Study Design

This was a single-center, prospective randomized pilot trial that compared use of the AMI Choice conversation tool to usual care in hospitalized patients after an acute MI.
The study, conducted between March 2009 and June 2010, included 106 adult patients who were admitted for acute MI, had no impairment to using the conversation tool, and were expected to be discharged to home.
The AMI Choice tool comprised a pictorial chart showing risk and risk reduction, an estimate of 6-month mortality based on the GRACE risk score, the potential risk reduction from use of prescribed medications, and the potential costs and risks of the medications.
The tool was used by nurse practitioners or registered clinical nurses with patients either on the day of or day before discharge. The NPs and RNs were trained in the use of the tool.
The patients in the usual care group discussed their medications with the nurses without the aid of the conversation tool or other extra training.
Both groups received pamphlets about their medications.
Assessment of patient knowledge, comfort, and how their care was delivered was performed with post-encounter surveys.
Adherence to medication was assessed by phone interviews at 5 weeks and 6 months after discharge, in addition to pharmacy records.

Key Results

The 53 patients in the AMI Choice group were more likely to give correct responses to the risk of mortality survey questions (50% vs 2%; P < .001), and to questions regarding risk reduction from their medications (62% vs 16%; P < .001), than the 53 in the usual care group.
However, there was no significant difference between the groups in terms of satisfaction with knowledge transfer, defined as the way knowledge was shared.
Based on video recordings, clinicians in the AMI Choice group were seen to encourage a high degree of patient involvement in decision-making with the patients in that group.
Regarding medication adherence among the 94 patients for whom prescription data was available, 86% of prescriptions were filled in the AMI Choice group vs 89% in the usual care group.
Full adherence to medications at 6 months was also similar between the AMI Choice group and usual care group at 78% and 73%, respectively. Aspirin use was also similar: 96% and 92%, respectively.

Limitations

The individuals conducting the study also developed the conversation tool and were clinicians in an academic medical center, making it hard to generalize the results to other settings.
The participants enrolled in the study had limited socio-economic diversity and were very adherent to medications, potentially limiting generalization to other populations.
The conversation tool was only used once during the hospitalizations; using it more than once could potentially have changed the study’s outcome.

Disclosures

The authors did not include disclosures.
Funding was provided by the Mayo Clinic.

This is a summary of a preprint research study, “Shared Decision Making for Patients Hospitalized With Acute Myocardial Infarction. A Randomized Trial,” written by Megan E. Branda, MS, from the Knowledge and Evaluation Research Unit, Department of Medicine, and the Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota , and colleagues, on MedRxiv, provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on medRxiv.org.

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