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Advancing Shared Decision Making for Stroke Prevention in Atrial Fibrillation: A Meta-Analysis of Randomized Trials of Decision Aids

Award Number: R21HL188524
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/01/2026
PERIOD OF PERFORMANCE END DATE: 05/31/2028

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Advancing Shared Decision Making for Stroke Prevention in Atrial Fibrillation: A Meta-Analysis of Randomized Trials of Decision Aids - Project Abstract Atrial fibrillation affects more than 10 million Americans and is a major contributor to stroke, heart failure, and premature death. While oral anticoagulation can reduce stroke risk by up to 70%, many patients with atrial fibrillation are either undertreated or receive care that is not concordant with their values and preferences. Shared decision making is a cornerstone of patient-centered care and is strongly recommended in national guidelines for atrial fibrillation management. Decision aids—tools designed to support shared decision making by helping patients understand their options and participate in decisions—have shown promise in improving decision quality and aligning treatment with patient goals. Despite this, critical knowledge gaps remain. Existing studies of decision aids in atrial fibrillation vary in design, type of decision aids (clinician- vs. patient-focused), populations, and outcomes, limiting our ability to draw generalizable conclusions. The research proposed in this application will address this gap through the first analysis of combined data from three large randomized controlled trials (RCTs) evaluating decision aids for stroke prevention in atrial fibrillation. Together, these trials represent the largest body of evidence on shared decision making interventions in atrial fibrillation and offer an unprecedented opportunity to rigorously assess their effectiveness. The work proposed here will evaluate the decision aids’ overall impact, identify populations and contexts in which the tools are more effective, and determine mechanisms of action. Specifically, in this research, patient-level data from three large RCTs of decision aids for stroke prevention in atrial fibrillation will be synthesized in order to: (1) quantify the overall effectiveness of decision aids on patient- centered and clinical outcomes, (2) identify the patient populations and system characteristics in which each type of decision aid is more and less effective, and (3) determine the mechanisms by which decision aids influence treatment decisions and outcomes, to inform implementation of patient-centered cardiovascular care. This project directly supports NHLBI’s mission to promote the prevention and treatment of heart, lung, and blood diseases and enhance the health of all individuals. By pooling data from three large RCTs, this analysis of individual patient data will produce the most definitive evidence to date on decision aids for stroke prevention in atrial fibrillation. Grounded in principles of decision science, the project will enhance understanding of how patients and clinicians make complex healthcare choices and how those choices can be optimized. It will inform future clinical guidelines, healthcare delivery strategies, and policy decisions related to shared decision making in the context of atrial fibrillation. In addition, the study will contribute robust empirical evidence to the field of decision science, advancing theoretical frameworks and methodological approaches for evaluating shared decision making. The findings will also guide the development of scalable, patient-focused shared decision making interventions across cardiovascular conditions.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $231,000 )
2026	2026	UNIVERSITY OF UTAH	201 PRESIDENTS CIR	SALT LAKE CITY	UT	84112	SALT LAKE	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	1	9/2/2026	NEW	$231,000
														Subtotal = $231,000

Grand Total All Awards = $231,000

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Advancing Shared Decision Making for Stroke Prevention in Atrial Fibrillation: A Meta-Analysis of Randomized Trials of Decision Aids

Award Number: R21HL188524

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/01/2026

PERIOD OF PERFORMANCE END DATE: 05/31/2028

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