Many hospitals create a shared decision-making process for patients with atrial fibrillation (AF) who undergo percutaneous left atrial appendage occlusion (pLAAO), but the implementation of this support varies widely between institutions. Josha B. Rager, MD, MA, MS, of the Indiana University School of Medicine, Indianapolis, and colleagues, reported these data in a manuscript published online Friday in JAMA Network Open. How have the guidelines for management of patients with AF influenced outcomes? The Centers for Medicare & Medicaid Services (CMS) uses shared decision-making as a requirement for reimbursement, particularly if patients with AF are undergoing pLAAO. Shared decision-making includes both the heart team and a patient decision aid (DA) in The investigators in this cohort study examined data from October 1, 2022, through June 30, 2024, from the American College of Cardiology’s National Cardiovascular Data Registry (NCDR) LAAO Registry, to determine the trends and use of shared-decision making for pLAAO in patients with AF. Patients who underwent pLAAO for the first time made up the study population. A total of 147,296 unique patient encounters (mean age=76.6 years, 58.8% male; 93.2% White, 3.5% Black, 3.4% Hispanic) were included in the analysis. A total of 830 institutions (59.4% urban, 30.7% suburban, 10.0% rural; 50.7% teaching hospitals) participated in the NCDR LAAO Registry, 99.9% of which reported shared decision-making outcomes and 98.4% reported use of a patient DA. Unadjusted, 64.7% of patient encounters reported that both shared decision-making and patient DA were present for pLAAO. Rates rose between October 2022 and June 2024 from 62.5% to 75.0%. When adjusted, the analysis revealed that variance in use of shared decision-making and patient DA was primarily due to the discretion of each institution (mean odds ratio [OR]=115.64; 95% confidence interval [CI]=79.71-151.56. A large range was present when determining the variance by institutional use of shared decision-making plus patient DA (0.1%-76.4%; mean=52.0%). Results were not significantly different in patients with Medicare (OR=1.03; 95% CI=0.98-1.09). Coding for shared decision-making and patient DA use was a noted limitation of this study, as it was mostly based on data from medical records. No general standards are set for how to measure shared decision-making. Additionally, the NCDR LAAO Registry is not required for centers to perform pLAAO, but it is the largest registry and database for reporting these cases. Patients who received shared decision support but did not end up undergoing pLAAO were not included in the analysis. Overall, patients with AF who underwent pLAAO for the first time had high rates of shared decision-making plus a patient DA present prior to the procedure, but these rates varied between clinical centers. Source: Rager JB, Huang CY, Zimmerman S, et al. Shared decision-making and patient decision aids for percutaneous left atrial appendage occlusion. JAMA Netw Open. 2026 February 13 (Article in Press). Image Credit: Mediteraneo – stock.adobe.com