What is the effectiveness of patient decision aids for cardiovascular decisions? sub-analysis of a systematic review

Patient decision aids (PtDAs) are evidence-based knowledge translation tools designed to help patients make informed health decisions aligned with their preferences. The aim of this sub-analysis was to determine the effectiveness of PtDAs when used with patients facing cardiovascular-related decisions. A sub-analysis of randomized controlled trials included in the 2023 update of the Cochrane review of PtDAs. Two reviewers independently screened 209 included trials to identify eligible trials of PtDAs for cardiovascular screening, prevention, and treatment decisions compared to usual care. Primary outcomes based on the International Patient Decision Aid Standards included attributes of the choice made (e.g., informed values-choice congruence) and attributes of the decision-making process (e.g., knowledge, accurate risk perceptions, decisional conflict related to feeling informed and feeling clear about values, participation in decision-making). Secondary outcomes were resource use and costs, including adverse effects. We conducted meta-analysis for similar outcome measures. Of 209 trials, 26 evaluated PtDAs for cardiovascular care, including 2 (7.7%) on screening, 4 (15.4%) on prevention, and 20 (76.9%) on treatment. Common decisions were about atrial fibrillation (n=6, 23.1%), prevention of cardiovascular disease (n=4, 15.4%), implantable cardioverter-defibrillators (n=3, 11.5%), left ventricular assist devices (n=3, 11.5%), and treatment of coronary artery disease (n=3, 11.5%). Regarding attributes of the choice made, PtDAs had a positive effect on congruence between informed values and choice compared to usual care/non-PtDA comparators (4 trials). Regarding attributes of the decision-making process, those exposed to PtDA had greater knowledge (MD 11.06; 95% CI 7.95-14.16; 17 trials), more accurate risk perceptions (RR 2.27; 95% CI 1.59-3.25; 7 trials), reduced decisional conflict related to feeling uninformed (MD -9.76; 95% CI -13.82 to -5.70; 12 trials) and related to unclear values (MD -8.03; 95% CI -11.62 to -4.44; 12 trials), and reduced clinician-controlled decision-making (RR 0.69; 95% CI 0.52-0.90; 4 trials) compared to usual care. For resource use, one trial measured use of general practitioner consultations and hospital appointments post-intervention and found no difference. No trials measured cost. There were no adverse effects. Twenty-six trials evaluated PtDAs for cardiovascular decisions. When patients facing cardiovascular health decisions are exposed to PtDAs, they are more knowledgeable, have more accurate risk perceptions, feel better informed, are clearer about their values, and are less passive in decision-making. Given this evidence, it is time to support necessary changes in cardiovascular clinical practices to ensure their implementation for better patient-centered decision-making.