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Atrial FibrillationENHANCE-AFNCT04096781

Engaging Patients to Help Achieve Increased Patient Choice and Engagement for AFib Stroke Prevention

A study testing SDMT in people with Atrial Fibrillation and Atrial Flutter, run by Stanford University at 5 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

A multi-center, randomized controlled 2-arm trial comparing the effectiveness of an innovative shared decision-making pathway and usual care for Atrial Fibrillation Stroke Prevention Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Atrial Fibrillation, Atrial Flutter, Stroke
What is being tested?
SDMT
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,001 participants
Where
5 sitesUnited States
Study dates
18 Dec 2019to 17 Aug 2022
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • ≥ 18 y/o
  • Non-valvular atrial fibrillation or atrial flutter (AFib)
  • CHA2DS2-VASc stroke score of:
  • Men: 1 or more
  • Women: 2 or more
  • Able to consent in English or Spanish (if resources allow) and follow study instructions

Who cannot join

  • Moderate to severe mitral stenosis
  • Mechanical valve replacement
  • Absolute contraindication to anticoagulation (Based on clinician judgment)
  • Indication for anticoagulation therapy for a condition other than atrial fibrillation
  • Left atrial appendage exclusion (by surgery or device placement)
  • At the clinical discretion of the investigator

Trial locations and contacts

5 sites in 1 country.

5 sites in 1 country

United States5 sites
  • Cooper University Hospital

    Camden, New Jersey, 08103

  • Cleveland Clinic Foundation

    Cleveland, Ohio, 931562

  • East Carolina University

    Greenville, North Carolina, 27858

  • Ochsner Medical Center

    New Orleans, Louisiana, 70121

  • Stanford University

    Palo Alto, California, 94305

Other trials in United States

About this study

A multi-center, randomized controlled 2-arm trial comparing the effectiveness of an innovative shared decision-making pathway and usual care for Atrial Fibrillation Stroke Prevention

Read the detailed description

This study will test to see if a new type of decision-making process tool, called a Shared Decision Making Pathway, can make a difference in decreasing the risk of stroke due to a condition called Atrial Fibrillation (AFib.) This online tool is designed to help doctors and patients decide together on treatment options for AFib.

Being tested
SDMT, Usual Care
Medical subject headings
Atrial Fibrillation, Atrial Flutter, Stroke, Heart Failure, Arrhythmias, Cardiac

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • SDMTBehavioural

    The intervention involves a clear pathway centered on the use of a web-based decision tool. This tool aims to support the shared decision-making process for anticoagulation for stroke prevention in atrial fibrillation. This web-based tool will be used both by the participants as well the physician responsible for atrial fibrillation decision making.

  • Usual CareBehavioural

    The participants will receive usual care.

Study groups in NCT04096781
Study groupRoleWhat they receive
Shared Decision Making Tool (SDMT)ExperimentalNot described
Receives: Behavioral: SDMT
Usual CareActive comparatorNot described
Receives: Behavioral: Usual Care

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Decisional Conflict Scale

    The Decisional Conflict Scale is a 16 Item scale on whether the participants have enough information to make a clear decision. Each item scored from 1-5, where 1 indicates clarity and 5 indicates confusion, with total score ranging from 16-80

    Measured: Visit 2 (1-month follow-up)

Secondary outcomes (15)
  1. Decisional Conflict Scale (16 items)

    The Decisional Conflict Scale is a 16 Item scale on whether the participants have enough information to make a clear decision. Each item scored from 1-5, where 1 indicates clarity and 5 indicates confusion, with total score ranging from 16-80

    Measured: Visit 1 (Post Clinic Visit), Visit 2 (1-month follow up), Visit 3 (6-month follow-up)

  2. Decision Regret Scale (5 items)

    Decision Regret Scale, is scored from 1-5, where 1 indicates they made the right decision and 5 indicates they made the wrong decision. This scale ranges from 5-25

    Measured: Visit 1 (Post Clinic Visit), Visit 2 (1-month follow up), Visit 3 (6-month follow-up)

  3. Weighted composite outcome scale according to patient preference

    Patient-selected weighted composite outcome scale is a composite scale to consider both decisional conflict and decisional regret scales simultaneously according to the priority based on the survey of 100 potential participants. The rationale for this endpoint is to consider not only the preference of majority patients (73%) but also the minority (27%) participants who prefer the decisional regret scale

    Measured: Visit 1 (Post Clinic Visit), Visit 2 (1-month follow up), Visit 3 (6-month follow-up)

  4. Preparation for Decision Making Scale (10 items)

    Preparation for Decision Making scale assesses a patient's perception of how useful a decision aid or other decision support intervention is in preparing the respondent to communicate with their practitioner at a consultation focused on making a health decision

    Measured: Visit 1 (Post Clinic Visit), Visit 2 (1-month follow up), Visit 3 (6-month follow-up)

  5. Utah-Stanford Atrial Fibrillation Knowledge Assessment

    Newly developed assessment for this study to record Atrial Fibrillation Knowledge

    Measured: Baseline, Visit 1 (Post Clinic Visit), Visit 2 (1-month follow up), Visit 3 (6-month follow-up)

  6. Quality of Communication (Based on CAHPS Clinician & Group Survey)

    CAHPS 3-item modified version

    Measured: Visit 1 (Post Clinic Visit)

  7. Atrial Fibrillation Severity Scale (AFSS)

    The University of Toronto Atrial Fibrillation Severity Scale (AFSS) is a questionnaire designed for patients with AFib. It consists of 19 items combined into 3 parts to capture total AF burden, health care utilization, and the severity of AFib related symptoms

    Measured: Baseline, Visit 2 (1-month follow up), Visit 3(6-month follow-up)

  8. Collaborative Agreement on Decision

    Assess the collaborative agreement (1. Patient Reported Outcome 2) Clinician Reported

    Measured: Visit 1 (Post Clinic Visit)

  9. Clinician Satisfaction of the Decision Aid: Physician Survey

    Clinician Satisfaction of the Decision Aid as assessed by a physician survey on shared decision making

    Measured: Visit 1 (Post Clinic Visit)

  10. Patient Satisfaction of the Decision Aid: Patient Survey

    Patient Satisfaction of the Decision Aid as assessed by Patient survey on shared decision making

    Measured: Visit 1 (Post Clinic Visit)

  11. Length of Visit at visit 1 (clinician)

    Compare treatment arm on the length of visit

    Measured: Visit 1 (Post Clinic Visit)

  12. Anticoagulant Choice (Patient follow up questions on Anticoagulant use)

    Decision on anticoagulation choice as assessed by patient follow up questions

    Measured: Visit 1 (Post Clinic Visit), Visit 2 (1-month follow up), Visit 3 (6-month follow-up)

  13. Anticoagulation Persistence and adherence (Patient follow up questions on Anticoagulant use)

    Persistence and adherence to anticoagulation among participants selecting anticoagulation, as assessed by Patient follow up questions

    Measured: Visit 2 (1-month follow up), Visit 3 (6-month follow-up)

  14. Stroke or TIA or Deep Venous Thrombosis or Pulmonary Embolus

    Incidence of Stroke or TIA or Deep Venous Thrombosis or Pulmonary Embolus

    Measured: Visit 2 (1-month follow up), Visit 3 (6-month follow-up), Unscheduled

  15. Death

    Incidence of Death

    Measured: Visit 2 (1-month follow up), Visit 3 (6-month follow-up), Unscheduled

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Sep 2019
  2. Study start18 Dec 2019
  3. Primary completion23 Jun 2022
  4. Study completion17 Aug 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Model description
A Shared Decision-Making pathway focused on a digital shared decision-making tool (SDMT) that is augmented by a clinician tool and an optional lay coach
Masking
None (open label)
Enrolment
1,001 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04096781
Sponsor's protocol ID
50864
Acronym
ENHANCE-AF
Status last verified
Apr 2024
First submitted
9 Sep 2019
Last updated
5 Apr 2024
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Baykaner T, Pundi K, Lin B, Lu Y, DeSutter K, Lhamo K, Garay G, Nunes JC, Morin DP, Sears SF, Chung MK, Paasche-Orlow MK, Sanders LM, Bunch TJ, Hills MT, Mahaffey KW, Stafford RS, Wang PJ. The ENHANCE-AF clinical trial to evaluate an atrial fibrillation shared decision-making pathway: Rationale and study design. Am Heart J. 2022 May;247:68-75. doi: 10.1016/j.ahj.2022.01.013. Epub 2022 Jan 28.

    PubMed 35092723
  • Nunes JC, Baykaner T, Pundi K, DeSutter K, True Hills M, Mahaffey KW, Sears SF, Morin DP, Lin B, Wang PJ, Stafford RS. Design and development of a digital shared decision-making tool for stroke prevention in atrial fibrillation. JAMIA Open. 2023 Feb 2;6(1):ooad003. doi: 10.1093/jamiaopen/ooad003. eCollection 2023 Apr.

    PubMed 36751465
  • Chung MK, Fagerlin A, Wang PJ, Ajayi TB, Allen LA, Baykaner T, Benjamin EJ, Branda M, Cavanaugh KL, Chen LY, Crossley GH, Delaney RK, Eckhardt LL, Grady KL, Hargraves IG, True Hills M, Kalscheur MM, Kramer DB, Kunneman M, Lampert R, Langford AT, Lewis KB, Lu Y, Mandrola JM, Martinez K, Matlock DD, McCarthy SR, Montori VM, Noseworthy PA, Orland KM, Ozanne E, Passman R, Pundi K, Roden DM, Saarel EV, Schmidt MM, Sears SF, Stacey D, Stafford RS, Steinberg BA, Youn Wass S, Wright JM. Shared Decision Making in Cardiac Electrophysiology Procedures and Arrhythmia Management. Circ Arrhythm Electrophysiol. 2021 Dec;14(12):e007958. doi: 10.1161/CIRCEP.121.007958. Epub 2021 Dec 6.

    PubMed 34865518
  • Pundi K, Baykaner T, True Hills M, Lin B, Morin DP, Sears SF, Wang PJ, Stafford RS. Blood Thinners for Atrial Fibrillation Stroke Prevention. Circ Arrhythm Electrophysiol. 2021 Jun;14(6):e009389. doi: 10.1161/CIRCEP.120.009389. Epub 2021 Jun 11. No abstract available.

    PubMed 34111936
  • Ajayi TB, Remein CD, Stafford RS, Fagerlin A, Chung MK, Childs E, Benjamin EJ. Cross-Center Virtual Education Fellowship Program for Early-Career Researchers in Atrial Fibrillation. Circ Arrhythm Electrophysiol. 2020 Nov;13(11):e008552. doi: 10.1161/CIRCEP.120.008552. Epub 2020 Oct 8.

    PubMed 33031707
  • Nunes, J.C., Shah, S., Fazal, M. et al. Patient Education Strategies to Improve Risk of Stroke in Patients with Atrial Fibrillation. Curr Cardiovasc Risk Rep 16, 249-258 (2022). https://doi.org/10.1007/s12170-022-00709-8.

  • Pourshams I, Lin B, Wang PJ, Stafford RS. Decision-Making Experiences and Decisional Regret in Patients Receiving Implanted Cardioverter-Defibrillators. Heart Mind 2022; 6(1): 32-5. doi: 10.4103/hm.hm_51_21

  • Wang PJ, Lu Y, Mahaffey KW, Lin A, Morin DP, Sears SF, Chung MK, Russo AM, Lin B, Piccini J, Hills MT, Berube C, Pundi K, Baykaner T, Garay G, Lhamo K, Rice E, Pourshams IA, Shah R, Newswanger P, DeSutter K, Nunes JC, Albert MA, Schulman KA, Heidenreich PA, Bunch TJ, Sanders LM, Turakhia M, Verghese A, Stafford RS. Randomized Clinical Trial to Evaluate an Atrial Fibrillation Stroke Prevention Shared Decision-Making Pathway. J Am Heart Assoc. 2023 Feb 7;12(3):e028562. doi: 10.1161/JAHA.122.028562. Epub 2023 Feb 7.

    PubMed 36342828

Questions about this trial

What is this clinical trial studying?

A study testing SDMT in people with Atrial Fibrillation and Atrial Flutter, run by Stanford University at 5 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 5 Apr 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 5 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Decisional Conflict Scale (time frame: Visit 2 (1-month follow-up)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04096781, which also lists 8 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Apr 2024.

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