Exploring patient–provider decision-making for use of anticoagulation for stroke prevention in atrial fibrillation: Results of the INFORM-AF study

Background:Atrial fibrillation is associated with stroke, yet approximately 50% of patients are not treated with guideline-directed oral anticoagulants (OACs).Aims:Given that the etiology of this gap in care is not well understood, we explored decision-making by patients and physicians regarding OAC use for stroke prevention in atrial fibrillation.Methods and results:We conducted a descriptive qualitative study among providers (N=28) and their patients with atrial fibrillation for whom OACs were indicated (N=25). We used purposive sampling across three outpatient settings in which atrial fibrillation patients are commonly managed: primary care (n=14), geriatrics (n=10), and cardiology (n=4). Eligible patients were stratified by those prescribed OAC (n=13) and not prescribed OAC (n=12). Semi-structured, in-depth interviews assessed decision-making regarding risk and OAC use. Classical content analysis was used to code narratives and identify themes. Results among patients consisted of the overarching theme...