Patient preferences for stroke prevention treatments in atrial fibrillation in Asia: A discrete choice experiment

Abstract

Objective: Stroke prevention in patients with atrial fibrillation should be adapted to patient needs and preferences. This study quantifies patient preferences for key characteristics of atrial fibrillation stroke prevention treatments in China, Taiwan, and South Korea. Methods: A discrete choice experiment (DCE) survey was developed based on a targeted literature review and discussions with clinical and methodological experts. The DCE included six attributes: risks of death, severe disabilities, mild or moderate disabilities, non-disabling events; intake with food; and dosing frequency. DCE data were analyzed using mixed multinomial logit models. Results: In January to March 2023, 307 participants completed the DCE in China (n = 155), Taiwan (n = 76), and South Korea (n = 76). Average time since atrial fibrillation diagnosis was 6.3 years. Participants preferred treatments with improved clinical outcomes, with reduced risk of death being their most important attribute. They valued a 1 % reduction in severe disability risk the same as a 0.36 % death risk reduction, a 1 % reduction in mild or moderate disability risk the same as a 0.25 % death risk reduction, and a 1 % reduction in non-disabling event risk the same as a 0.18 % death risk reduction. Participant preferences on intake with food and dosing frequency were more heterogeneous than for clinical outcomes. Conclusion: Patients with atrial fibrillation were willing to accept an increased risk of non-disabling events in exchange for a reduced risk of death but had diverse preferences for treatment administration characteristics. These findings can inform patient-centered treatment strategies that consider the relative importance of treatment attributes in clinical decision-making.

Keywords

• Atrial fibrillation
• Stroke prevention
• Direct oral anticoagulant
• Discrete choice experiment
• Treatment attributes
• Patient preferences