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Heartbeat: shared decision making in care of patients with cardiovascular disease
  1. Catherine M Otto
  1. Division of Cardiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Professor Catherine M Otto, Division of Cardiology, University of Washington, Seattle, WA 98195, USA; cmotto{at}

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Shared decision making (SDM) has become a central tenet in our care of patients with cardiovascular disease. However, the effectiveness of SDM for improving patient centered outcomes is uncertain. In this issue of Heart, Mitropoulou and colleagues1 report a meta-analysis of 18 randomised controlled trials of SDM, with measurement of at least one outcome measure. In these 4419 patients, increased use of SDM, compared with standard care, reduced decisional conflict and increased patient knowledge (figure 1). The areas for SDM in these studies included evaluation of chest pain for coronary artery disease, anticoagulation for atrial fibrillation, cardiac devices and advanced treatment options.

Figure 1

Meta-analysis summary. Effect of interventions to increase shared decision making on decisional conflict and on patient knowledge are shown using the standardised mean difference of scores. weights are derived from the random-effects model.

In the accompanying editorial, Lauck and Lewis2 summarise the principles of optimal SDM (figure 2) and point out that “patients who experience shared decision-making report an increased sense of control in managing their illness and improved communication with their healthcare providers, and are more likely to engage in their care and treatment.” Even so, there are many barriers to increased use of SDM in clinical practice.3–6 They conclude that “based on the inclusion of shared decision-making in multiple international guidelines, it is no longer a matter of ‘if’ but rather ‘when’ and ‘how’ …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.