# Improving Outcomes in Atrial Fibrillation Through Patient-Centered Decision Making

> **NIH NIH K01** · CLEVELAND CLINIC LERNER COM-CWRU · 2021 · $139,239

## Abstract

Project Summary
Dr. Martinez is a junior faculty member at the Medicine Institute Center for Value-Based Care Research and
Associate Staff in the Department of Internal Medicine at the Cleveland Clinic in Cleveland, OH. The goal of
this career development award is to provide training in administrative data analysis, risk modeling, and
qualitative research methods to examine variation in evidence-based anticoagulation among patients with atrial
fibrillation, and to identify strategies to improve outcomes in atrial fibrillation through patient-centered decision
making. Atrial fibrillation is the most common cardiac rhythm disorder and is associated with a five-fold
increased risk of stroke. Treatment with anticoagulation can reduce stroke risk by up to 60%, yet these drugs
are widely underutilized. Anticoagulation poses a risk of bleeding, which must be weighed against the
predicted benefit of stroke reduction. However, physicians and patients value the tradeoffs associated with
anticoagulation differently. Patients prioritize avoiding disabling strokes, while physicians are wary of causing
bleeds. Physicians often overestimate individual patients’ bleeding risk, thereby failing to prescribe
anticoagulation to patients likely to benefit. Risk prediction tools can help physicians make evidence-based
anticoagulation decisions, but use of these tools is inconsistent. Patient preferences for the tradeoffs
associated with anticoagulation vary, but are rarely assessed. Given patients’ higher valuation of stroke
reduction, improved patient-centered decision making may increase the uptake of anticoagulation among
patients likely to benefit. In this career development award, Dr. Martinez proposes four phases of investigation,
and in so doing will acquire new skills and competencies critical to achieving her goal of becoming an expert in
patient-centered decision making for anticoagulation. In Aim 1, Dr. Martinez will use a decision analytic model
to examine optimal versus actual anticoagulation prescribing in a large integrated health system. In Aim 2, she
will evaluate the nature of patient and physician communication regarding anticoagulation decisions, with a
particular emphasis on how physicians present anticoagulation risks and benefits. Because a key barrier to
optimal prescribing is physician over-valuation of bleeding risk, Aim 3 will be a pilot study to evaluate the
impact of a pharmacist-led decision intervention on improving evidence-based and patient-centered
anticoagulation decision making. Finally, in Aim 4, Dr. Martinez will convene patient focus groups and conduct
physician interviews to identify specific opportunities to improve patient-centered decision making for
anticoagulation. In addition to advanced training through formal coursework, this career development award is
supported by an exceptional mentoring team, including nationally-recognized experts in risk modeling and
patient-centered outcomes research. The combination of formal tra...

## Key facts

- **NIH application ID:** 10141283
- **Project number:** 5K01HL136656-04
- **Recipient organization:** CLEVELAND CLINIC LERNER COM-CWRU
- **Principal Investigator:** Kathryn Anne Martinez
- **Activity code:** K01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $139,239
- **Award type:** 5
- **Project period:** 2018-05-01 → 2023-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10141283

## Citation

> US National Institutes of Health, RePORTER application 10141283, Improving Outcomes in Atrial Fibrillation Through Patient-Centered Decision Making (5K01HL136656-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10141283. Licensed CC0.

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