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Hengstenberg C, Van Mieghem NM, Wang R, Ye X, Shi L, Guo S, Chen C, Jin J, Ye X, Dangas G, Unverdorben M. Treatment Satisfaction and Convenience for Patients With Atrial Fibrillation on Edoxaban or Vitamin K Antagonists After Transcatheter Aortic Valve Replacement: A Post Hoc Analysis from the ENVISAGE-TAVI AF Trial. Am J Cardiol 2023; 209:212-219. [PMID: 37848174 DOI: 10.1016/j.amjcard.2023.09.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/14/2023] [Accepted: 09/24/2023] [Indexed: 10/19/2023]
Abstract
ENVISAGE-TAVI AF (Edoxaban versus Standard of Care and Their Effects on Clinical Outcomes in Patients Having Undergone Transcatheter Aortic Valve Implantation-Atrial Fibrillation; NCT02943785) was a prospective, randomized, open-label trial comparing non-vitamin K oral anticoagulant (NOAC) edoxaban with vitamin K antagonists (VKAs) in patients with atrial fibrillation after successful transcatheter aortic valve replacement (TAVR). The effect of edoxaban- or VKA-based therapy on patient-reported outcomes remains unknown, as most studies focus on efficacy and safety. Pre-TAVR patient-reported expectations and post-TAVR Treatment Satisfaction and Convenience with edoxaban or VKA treatment (at months 3 and 12) were analyzed using the Perception of Anticoagulation Treatment Questionnaire (PACT-Q). This analysis included randomized and dosed patients with an evaluable PACT-Q1 assessment at baseline and ≥1 postbaseline assessment (PACT-Q2). Subanalyses included patients stratified by pre-TAVR anticoagulant (NOAC, VKA, no NOAC/VKA). Edoxaban- (n = 585) and VKA-treated (n = 522) patients had similar baseline characteristics and treatment expectations. Pre-TAVR anticoagulant use did not affect treatment expectations. After TAVR, edoxaban-treated patients had significantly higher Treatment Satisfaction and Convenience scores compared with VKA-treated patients at all time points (p <0.001 for all). Among edoxaban-treated patients, those who received VKAs pre-TAVR were significantly more satisfied with treatment than those who received NOACs (p <0.001) or no NOACs/VKAs (p = 0.003); however, there was no significant difference in the perception of convenience (p = 0.927 and p = 0.092, respectively). Conversely, among VKA-treated patients, the type of anticoagulant used pre-TAVR did not affect Treatment Satisfaction or Convenience scores post-TAVR. In conclusion, patients with atrial fibrillation who received edoxaban post-TAVR reported significantly higher Treatment Satisfaction and Convenience scores compared with those who received VKAs, resulting in a clinically meaningful difference between treatment groups.
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Affiliation(s)
- Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University, Vienna, Austria.
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, The Netherlands
| | - Rosa Wang
- Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | - Xiaomei Ye
- Clinical Outcomes Analytics, Evidera PPD, LLC, Bethesda, Maryland
| | - Ling Shi
- Clinical Outcomes Analytics, Evidera PPD, LLC, Bethesda, Maryland
| | - Shien Guo
- Clinical Outcomes Analytics, Evidera PPD, LLC, Bethesda, Maryland
| | - Cathy Chen
- Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | - James Jin
- Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | - Xin Ye
- Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | - George Dangas
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York; School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Lucà F, Oliva F, Abrignani MG, Di Fusco SA, Parrini I, Canale ML, Giubilato S, Cornara S, Nesti M, Rao CM, Pozzi A, Binaghi G, Maloberti A, Ceravolo R, Bisceglia I, Rossini R, Temporelli PL, Amico AF, Calvanese R, Gelsomino S, Riccio C, Grimaldi M, Colivicchi F, Gulizia MM. Management of Patients Treated with Direct Oral Anticoagulants in Clinical Practice and Challenging Scenarios. J Clin Med 2023; 12:5955. [PMID: 37762897 PMCID: PMC10531873 DOI: 10.3390/jcm12185955] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/22/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
It is well established that direct oral anticoagulants (DOACs) are the cornerstone of anticoagulant strategy in atrial fibrillation (AF) and venous thromboembolism (VTE) and should be preferred over vitamin K antagonists (VKAs) since they are superior or non-inferior to VKAs in reducing thromboembolic risk and are associated with a lower risk of intracranial hemorrhage (IH). In addition, many factors, such as fewer pharmacokinetic interactions and less need for monitoring, contribute to the favor of this therapeutic strategy. Although DOACs represent a more suitable option, several issues should be considered in clinical practice, including drug-drug interactions (DDIs), switching to other antithrombotic therapies, preprocedural and postprocedural periods, and the use in patients with chronic renal and liver failure and in those with cancer. Furthermore, adherence to DOACs appears to remain suboptimal. This narrative review aims to provide a practical guide for DOAC prescription and address challenging scenarios.
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Affiliation(s)
- Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | - Fabrizio Oliva
- Cardiology Department De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
| | | | - Stefania Angela Di Fusco
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00135 Roma, Italy
| | - Iris Parrini
- Cardiology Department, Ospedale Mauriziano, 10128 Turin, Italy
| | - Maria Laura Canale
- Cardiology Department, Nuovo Ospedale Versilia Lido di Camaiore Lucca, 55049 Camaiore, Italy
| | - Simona Giubilato
- Cardiology Department, Cannizzaro Hospital, 95126 Catania, Italy
| | - Stefano Cornara
- Arrhytmia Unit, Division of Cardiology, Ospedale San Paolo, Azienda Sanitaria Locale 2, 17100 Savona, Italy
| | | | - Carmelo Massimiliano Rao
- Cardiology Department, Grande Ospedale Metropolitano, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | - Andrea Pozzi
- Cardiology Division Valduce Hospital, 22100 Como, Italy
| | - Giulio Binaghi
- Department of Cardiology, Azienda Ospedaliera Brotzu, 09047 Cagliari, Italy
| | - Alessandro Maloberti
- Cardiology Department De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
| | - Roberto Ceravolo
- Cardiology Unit, Giovanni Paolo II Hospital, 88046 Lamezia, Italy
| | - Irma Bisceglia
- Integrated Cardiology Services, Department of Cardio-Thoracic-Vascular, Azienda Ospedaliera San Camillo Forlanini, 00152 Rome, Italy
| | - Roberta Rossini
- Cardiology Unit, Ospedale Santa Croce e Carle, 12100 Cuneo, Italy;
| | - Pier Luigi Temporelli
- Division of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, 28010 Gattico-Veruno, Italy
| | | | | | - Sandro Gelsomino
- Cardiovascular Research Institute, Maastricht University, 6211 LK Maastricht, The Netherlands
| | - Carmine Riccio
- Cardiovascular Department, Sant’Anna e San Sebastiano Hospital, 81100 Caserta, Italy
| | - Massimo Grimaldi
- Department of Cardiology, General Regional Hospital “F. Miulli”, 70021 Bari, Italy
| | - Furio Colivicchi
- Clinical and Rehabilitation Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00135 Roma, Italy
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Adelakun AR, Turgeon RD, De Vera MA, McGrail K, Loewen PS. Oral anticoagulant switching in patients with atrial fibrillation: a scoping review. BMJ Open 2023; 13:e071907. [PMID: 37185198 PMCID: PMC10151984 DOI: 10.1136/bmjopen-2023-071907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Oral anticoagulants (OACs) prevent stroke in patients with atrial fibrillation (AF). Several factors may cause OAC switching. OBJECTIVES To examine the phenomenon of OAC switching in patients with AF, including all available evidence; frequency and patterns of switch, clinical outcomes, adherence, patient-reported outcomes, reasons for switch, factors associated with switch and evidence gaps. DESIGN Scoping review. DATA SOURCES MEDLINE, Embase and Web of Science, up to January 2022. RESULTS Of the 116 included studies, 2/3 examined vitamin K antagonist (VKA) to direct-acting OAC (DOAC) switching. Overall, OAC switching was common and the definition of an OAC switch varied across. Switching from VKA to dabigatran was the most prevalent switch type, but VKA to apixaban has increased in recent years. Patients on DOAC switched more to warfarin than to other DOACs. OAC doses involved in the switches were hardly reported and patients were often censored after the first switch. Switching back to a previously taken OAC (frequently warfarin) occurred in 5%-21% of switchers.The risk of ischaemic stroke and gastrointestinal bleeding in VKA to DOAC switchers compared with non-switchers was conflicting, while there was no difference in the risk of other types of bleeding. The risk of ischaemic stroke in switchers from DOAC versus non-switchers was conflicting. Studies evaluating adherence found no significant changes in adherence after switching from VKA to DOAC, however, an increase in satisfaction with therapy were reported. Reasons for OAC switch, and factors associated with OAC switch were mostly risk factors for stroke and bleeding. Clinical outcomes, adherence and patient-reported outcomes were sparse for switches from DOACs. CONCLUSIONS OAC switching is common in patients with AF and patients often switch back to an OAC they have previously been on. There are aspects of OAC switching that have received little study, especially in switches from DOACs.
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Affiliation(s)
- Adenike R Adelakun
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ricky D Turgeon
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter S Loewen
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada
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Troisi F, Guida P, Vitulano N, Quadrini F, Di Monaco A, Grimaldi M. Safety and efficacy of direct oral anticoagulants versus vitamin K antagonists in atrial fibrillation electrical cardioversion: An update systematic review and meta-analysis. Int J Cardiol 2023; 379:40-47. [PMID: 36907451 DOI: 10.1016/j.ijcard.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND A systematic evaluation focused on efficacy and safety for electrical cardioversion of atrial fibrillation (AF) among different Direct Oral Anticoagulants (DOACs) has not been previously performed. In this setting, we conducted a meta-analysis of studies evaluating DOACs vs vitamin K antagonists (VKA) as common comparator. METHODS We searched Cochrane Library, Pubmed, Web Of Science and Scopus databases for all English-only articles concerning studies that have estimated the effect of DOACs and VKA on stroke, transient ischemic attack or systemic embolism (SSE) and major bleeding (MB) events in AF patients undergoing electrical cardioversion. We selected 22 articles comprising 66 cohorts and 24,322 procedures (12,612 with VKA). RESULTS During follow-up (studies' median 42 days), 135 SSE (52 DOACs and 83 VKA) and 165 MB (60 DOACs and 105 VKA) were recorded. The overall pooled effects, DOACs vs VKA, was estimated by an univariate Odds Ratio of 0.92 (0.63-1.33; p = 0.645) for SSE and 0.58 (0.41-0.82; p = 0.002) for MB; at bivariate evaluation, adjusting for study type, were respectively 0.94 (0.55-1.63; p = 0.834) and 0.63 (0.43-0.92, p = 0.016). Each single DOAC showed similar and non statistically different results in outcome occurrence compared to VKA as well as when Apixaban, Dabigatran, Edoxaban and Rivaroxaban were indirectly compared to each other. CONCLUSIONS In patients undergoing electrical cardioversion, compared to VKA, DOACs have similar thromboembolic protection with lower major bleeding incidence. Single molecule does not show difference in event rate compared to each other. Our findings, provide useful information about safety and efficacy profile of DOACs and VKA.
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Affiliation(s)
- Federica Troisi
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy.
| | - Pietro Guida
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Nicola Vitulano
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Federico Quadrini
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Antonio Di Monaco
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Massimo Grimaldi
- Cardiology Department, Regional General Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
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Kager CC, Horsselenberg M, Korevaar JC, Wagner C, Hek K. Pattern of oral anticoagulant prescribing for atrial fibrillation in general practice: an observational study in The Netherlands. BJGP Open 2023; 7:BJGPO.2022.0179. [PMID: 36720562 DOI: 10.3399/bjgpo.2022.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/18/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In the Dutch atrial fibrillation (AF) guideline for GPs, vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) are seen as equivalent, while in cardiology there is a preference for DOACs. AIM To describe the pattern of oral anticoagulant (OAC) prescribing for AF by GPs and assess whether GPs proactively convert between VKAs and DOACs in patients with AF. DESIGN & SETTING Observational study using routine practice data from 214 general practices, from 2017 until 2019. METHOD Patients aged ≥60 years diagnosed with AF, who had been prescribed OACs by their GPs in 2018 were included. A distinction was made between starters, who were participants who did not use OACs in 2017, and prevalent users. It was observed and recorded whether patients switched between VKAs and DOACs. RESULTS A total of 12 516 patients with AF were included. Four hundred and seventy-six patients (4%) started OACs in 2018; 12 040 patients were prevalent OAC users. When GPs started patients on OACs, DOACs were prescribed the most (88%). Among prevalent users, more than half of the patients used VKAs (60%). GPs switched between OACs for 1% of starters and 0.6% of prevalent users in 2018 and 2019. CONCLUSION Dutch GPs predominantly start with DOACs in newly diagnosed patients with AF. Prevalent patients predominantly use VKAs and switching from a DOAC to a VKA is unusual. Consequently, the number of patients using VKAs will decline in the upcoming years. This trend raises questions about the future of organising frequent international normalised ratio (INR) checks for VKA users.
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Affiliation(s)
- Catharina Cm Kager
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Maaike Horsselenberg
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Karin Hek
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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Salmasi S, Safari A, Kapanen A, Adelakun A, Kwan L, MacGillivray J, Andrade JG, Deyell MW, Loewen P. Oral anticoagulant adherence and switching in patients with atrial fibrillation: A prospective observational study. Res Social Adm Pharm 2022; 18:3920-3928. [PMID: 35753963 DOI: 10.1016/j.sapharm.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Adherence to oral anticoagulants (OACs) in patients with atrial fibrillation (AF) is important in preventing stroke. The dominance of retrospective studies using administrative data has led to a lack of data on psychosocial determinants of adherence and prevented comparison of adherence between OAC drug classes. OAC switching is another aspect of adherence that is unexplored. METHODS A prospective design was utilized to measure AF patients' self-reported adherence and OAC switching, and to identify their clinical, demographic, and psychosocial determinants. Participants were recruited from specialized AF clinics in Canada and followed for up to 2 years. Data were collected via telephone every 3-4 months using a structured survey. Adherence was measured using the Morisky Medication Adherence scale (©MMAS-8). RESULTS The included participants (N = 306) were followed for a median follow up time of 14.1 months and had an average of 3.2(SD 1.4) study visits. The mean self-reported adherence on the ©MMAS-8 was 7.28(SD 0.71) for patients receiving care at specialized AF clinics. Older age, experiencing a bleed, and higher satisfaction with the burden of medications were significantly associated with higher adherence. Drug class did not have any significant impact on adherence. 7.8% of the cohort experienced a switch with most of them being from warfarin to DOAC. Taking warfarin as the index medication, experiencing a bleed and older age were significantly associated with higher odds of switching. CONCLUSION Patients with AF reported high adherence to their OAC therapy however being on DOAC may not translate to better adherence compared to VKA. Improving satisfaction with the burden of therapy is important in improving adherence.
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Affiliation(s)
- Shahrzad Salmasi
- Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Abdollah Safari
- Faculty of Pharmaceutical Sciences, University of British Columbia, Canada; Data Analytics, Statistics and Informatics, Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Anita Kapanen
- Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Adenike Adelakun
- Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Canada
| | - Leanne Kwan
- Atrial Fibrillation Clinic, Royal Columbian Hospital, New Westminster, Canada
| | - Jenny MacGillivray
- Atrial Fibrillation Clinic, Vancouver General Hospital, Vancouver, Canada
| | - Jason G Andrade
- Atrial Fibrillation Clinic, Vancouver General Hospital, Vancouver, Canada; Division of Cardiology, Faculty of Medicine, The University of British Columbia, Canada; UBC Centre for Cardiovascular Innovation, Vancouver, Canada
| | - Marc W Deyell
- Division of Cardiology, Faculty of Medicine, The University of British Columbia, Canada; UBC Centre for Cardiovascular Innovation, Vancouver, Canada; Atrial Fibrillation Clinic, St. Paul's Hospital, Vancouver, Canada
| | - Peter Loewen
- Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Canada; UBC Centre for Cardiovascular Innovation, Vancouver, Canada.
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The Influence of Frailty Syndrome and Dementia on the Convenience and Satisfaction with Oral Anticoagulation Treatment in Elderly Patients with Atrial Fibrillation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095355. [PMID: 35564748 PMCID: PMC9101389 DOI: 10.3390/ijerph19095355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022]
Abstract
Background: The impact of frailty syndrome (FS) and dementia on the convenience and satisfaction with oral anticoagulation (OAC) treatment in atrial fibrillation (AF) patients is not well-known. Aim: Assessment the impact of FS and dementia on the convenience and satisfaction with OAC treatment in 116 elderly (mean age 75.2, SD = 8.2) patients with AF. Methodology: A self-administered questionnaire was used in the study to collect basic socio-demographic and clinical data. Tilburg Frailty Indicator (TFI) questionnaire was used to assess the presence of FS, Mini Mental State Examination (MMSE) to assess cognitive impairment (CI), The Perception of Anticoagulant Treatment Questionnaire Part 2 (PACT-Q2) to assess convenience and satisfaction with OAC treatment, and the Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia (ASTA) to assess quality of life (QoL). Results: Multivariable analysis as a significant, negative predictor of the convenience and satisfaction domain showed the occurrence of dementia (β = −0.34; p < 0.001, β = −0.41; p < 0.001, respectively) and prior major bleeding (β = −0.30; p < 0.001, β = −0.33; p < 0.001, respectively). Analysis showed a significant relationship between convenience and satisfaction and the overall result of the ASTA (r = −0.329; p < 0.001, r = −0.372; p < 0.001, respectively). Conclusions: Elements of geriatric syndrome, such as FS and dementia, adversely affect treatment convenience and satisfaction with OAC treatment in AF. It has been shown that better convenience and satisfaction with OAC treatment translates into better QoL. There were no differences between satisfaction and convenience and the type of OAC treatment (vitamin K antagonists (VKA) vs. novel oral anticoagulants (NOAC).
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Abu Hamdeh H, Al-Jabi SW, Koni A, Zyoud SH. Health-related quality of life and treatment satisfaction in Palestinians with rheumatoid arthritis: a cross-sectional study. BMC Rheumatol 2022; 6:19. [PMID: 35382894 PMCID: PMC8985358 DOI: 10.1186/s41927-022-00251-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/10/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Studying health-related quality of life (HRQoL) and treatment satisfaction have helped in understanding how to optimize rheumatoid arthritis (RA) treatment outcomes and find ways to alleviate signs and symptoms among patients. OBJECTIVE In this study, our objective was to evaluate the association between satisfaction with care and HRQoL among RA patients from northern Palestine. In addition, this study also aimed to determine the associations between the clinical characteristics of patients with RA with treatment satisfaction and HRQoL. METHODS This was a multicenter cross-sectional study conducted between July and October 2018. Patients with RA diagnosis who presented at rheumatology clinics were interviewed. The SF-36 short questionnaire was used to assess HRQoL and Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4 to assess treatment satisfaction among study groups. We use descriptive and comparative statistics to present the results. RESULTS A total of 283 patients were included. Several sociodemographic and clinical characteristics were found to be associated with poor HRQoL scores and low treatment satisfaction. The physical component summary (PCS) was negatively associated with age, patients' self-reported disease activity, duration of the disease, and the total number of medications taken by the patient, and was positively associated with educational background, employment, and household income. The mental component summary (MCS) was negatively associated with patients' self-reported disease activity and the patient's total number of comorbid diseases. The number of comorbid diseases was negatively associated with effectiveness. All HRQoL subscales were significantly correlated with treatment satisfaction. The range of correlation with PCS was between 0.272 for convenience and 0.425 for side effects (p < 0.001). Similarly, the highest correlation with MCS was 0.458 for side effects, and the lowest was 0.337 for convenience (p < 0.001). CONCLUSIONS The current study found that HRQoL was significantly correlated with treatment satisfaction. Furthermore, the results of this study showed that HRQoL and treatment satisfaction are likely to be affected by sociodemographic and clinical characteristics. These results may be beneficial in clinical practice, mainly in the early treatment of patients with RA, at a stage where it is still possible to increase treatment satisfaction.
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Affiliation(s)
- Heba Abu Hamdeh
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Samah W. Al-Jabi
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Amer Koni
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Division of Clinical Pharmacy, Hematology and Oncology Department, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Clinical Research Centre, An-Najah National University Hospital, Nablus, 44839 Palestine
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Al-Jabi SW, Dalu AA, Koni AA, Khdour MR, Taha AA, Amer R, Zyoud SH. The relationship between self-efficacy and treatment satisfaction among patients with anticoagulant therapy: a cross-sectional study from a developing country. Thromb J 2022; 20:15. [PMID: 35379235 PMCID: PMC8978358 DOI: 10.1186/s12959-022-00374-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/23/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Thromboembolic events are a common complicated health problem. Although anticoagulants have several positive effects on these conditions, they also have several characteristics that strongly affect compliance and satisfaction. The purpose of this investigation is to explore the association between treatment satisfaction and self-efficacy in a sample of patients using anticoagulation therapy and determine the influence of sociodemographic and clinical factors on both aspects. METHODS This was a cross-sectional exploratory study carried out in Palestine. The Arabic version of the Anti-Coagulant Treatment Satisfaction Scale (ACTS) assessed treatment satisfaction. In addition, the Arabic version of the 6-Item Self-Efficacy for Managing Chronic Diseases (SES6C) was used to assess self-efficacy. RESULTS A total of 300 patients using anticoagulants (average age 51.95 and SD 17.98) were included. There is a modest correlation between treatment satisfaction and self-efficacy (r = 0.345; p < 0.001). The mean and median self-efficacy scores were 38.41 ± 9.88 and 39.00 (interquartile range: 33.00-46.00), respectively. Overall, patients reported a moderate burden and benefit score. The mean and median of the acting burden were 43.30 ± 10.45, and 43.30 (interquartile range: 36.00 to 51.00), respectively. The results showed that young age, higher education, employment, use of fewer medications, and having fewer diseases were significantly associated with higher self-efficacy behaviors. The results also showed that new oral anti-coagulants (NOACs) had a higher degree of self-efficacy and ACTS benefit scores (41.00 (33.75-47.00), p = 0.002; 13.00 (12.00-15.00), p < 0.001, respectively), than vitamin k antagonists (VKA). CONCLUSIONS The results demonstrated a significant relationship between treatment satisfaction and self-efficacy, and certain sociodemographic and clinical characteristics influence both. We found that there is a higher degree of self-efficacy and treatment satisfaction among patients who use NOACs than those who use UFH / VKA. Therefore, patients should be motivated to increase their knowledge about anticoagulant therapy. Healthcare providers should play an active role in educating patients, increasing their self-esteem, and awareness about anticoagulant drugs. Importantly, this study was an explanatory one, and it includes a low proportion of patients with venous thromboembolism. This encourages future research on a large scale of patients, considering the indications of anticoagulant therapy.
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Affiliation(s)
- Samah W. Al-Jabi
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Amal Abu Dalu
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Amer A. Koni
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Division of Clinical Pharmacy, Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Maher R. Khdour
- grid.16662.350000 0001 2298 706XFaculty of Pharmacy, Al-Quds University, Abu Deis, Jerusalem, 51000 Palestine
| | - Adham Abu Taha
- grid.11942.3f0000 0004 0631 5695Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Department of Pathology, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Riad Amer
- grid.11942.3f0000 0004 0631 5695Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Clinical Research Center, An-Najah National University Hospital, Nablus, 44839 Palestine
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10
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Wu Y, Dong S, Li X, Xu H, Xie X. The Transcultural Adaptation and Validation of the Chinese Version of the Duke Anticoagulation Satisfaction Scale. Front Pharmacol 2022; 13:790293. [PMID: 35281922 PMCID: PMC8904917 DOI: 10.3389/fphar.2022.790293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The Duke Anticoagulation Satisfaction Scale (DASS) offers a method to measure the quality of life and satisfaction of patients taking oral anticoagulants. The study aimed to validate the Chinese version of the DASS in Chinese patients on anticoagulation therapy. Methods: The DASS was translated, back-translated, and transculturally adapted into the Chinese version and then administered to participants taking oral anticoagulants in a physician-pharmacist collaborative anticoagulation clinic at a tertiary teaching hospital from October 2019 to December 2020. Reliability was analyzed through Cronbach's alpha (α) and split-half reliability. Confirmatory factor analysis was performed to test the structural validity of the scale. Exploratory factor analysis was performed for items in the scales using the varimax rotation method. Results: A total of 189 patients completed the Chinese version of the DASS. Four dimensions and 23 items were included, with Cronbach's α values of 0.89, 0.81, 0.89, and 0.74 for limitations on physical activities, diet restrictions, hassles and burdens, and positive psychological effect, respectively. Cronbach's α coefficient of whole scale was 0.91. The split-half reliability of this scale is 0.747 (>0.7). Conclusion: The Chinese version of the DASS indicated excellent reliability and validity, compared to the original version. It could provide a practical instrument for healthcare practitioners to evaluate satisfaction and quality of life for anticoagulated patients in China. The difference in quality of life between patients taking warfarin and novel oral anticoagulants (NOACs) needs to be further explored in future studies.
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Affiliation(s)
- Yibo Wu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Shujie Dong
- Department of Pharmacy, Peking University Third Hospital, Beijing, China
| | - Xinyi Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Haiping Xu
- School of Pharmaceutical Sciences, Shandong University, Jinan, China
| | - Xiaohui Xie
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
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11
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Dsouza JP, Chakrabarty J, Ramachandran P, Guddattu V, Nayak BS, George A. Effectiveness of a Nursing Intervention Module on Adherence, Knowledge, Quality of Life, and Complications Among Patients Receiving Anticoagulation therapy-a Randomized Controlled Trial Protocol. Patient Prefer Adherence 2022; 16:1723-1731. [PMID: 35903081 PMCID: PMC9314451 DOI: 10.2147/ppa.s365585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are one of the major causes of mortality at the global level. They account for approximately 17.9 million deaths per year. Warfarin and acenocoumarol are the commonly used oral anticoagulants to treat and prevent thromboembolic disorders in patients with cardiovascular diseases. In India, approximately 2-2.5 million patients with rheumatic heart disease are receiving oral anticoagulation therapy. Additionally, this therapy is provided for stroke prevention in the case of atrial fibrillation and the treatment of valvular heart disease, stroke, and deep vein thrombosis. As the therapeutic range of these drugs is narrow and is affected by many factors, their use is challenging. This study aims to evaluate the effectiveness of a nursing intervention module in terms of adherence to therapy, knowledge, quality of life, and complications among patients receiving oral anticoagulation therapy. Furthermore, this study will address factors that affect adherence and the risk for bleeding by using a randomized controlled trial design. METHODS This single-blind, single-center, randomized controlled trial will focus on adherence to oral anticoagulation therapy. A total of 320 patients who are on oral anticoagulation therapy will be randomized into blocks and allocated to either the intervention or standard care group. The intervention will comprise the use of a nursing intervention module that includes a booklet, log sheet, and decision aid on oral anticoagulation therapy adherence. Outcome measures, that is, knowledge regarding oral anticoagulation therapy, adherence, complications, and quality of life, will be assessed at the baseline and during follow-ups. DISCUSSION Patient safety can be best achieved through patients' adherence to medication dose and monitoring of blood test values. Thromboembolic and bleeding complications are likely to occur when either the patient does not adhere to the treatment or the therapeutic range of the international normalized ratio is not maintained. This study will assess the nonadherence behavior and the effectiveness of a nursing intervention module toward adherence behavior. TRIAL REGISTRATION This research project is registered under the Clinical Trial Registry of India (CTRI/2019/06/019610).
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Affiliation(s)
- Janet Prameela Dsouza
- Department of Medical-Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jyothi Chakrabarty
- Department of Medical-Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Correspondence: Jyothi Chakrabarty, Professor and Head, Department of Medical-Surgical Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India, Tel +91 9880078542, Email
| | - Padmakumar Ramachandran
- Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Padmakumar Ramachandran, Professor and Unit Head, Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India, Tel +91 9900921428, Email
| | - Vasudeva Guddattu
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Baby S Nayak
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anice George
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
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12
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Moudallel S, van Laere S, Cornu P, Dupont A, Steurbaut S. Assessment of adherence, treatment satisfaction and knowledge of direct oral anticoagulants in atrial fibrillation patients. Br J Clin Pharmacol 2021; 88:2419-2429. [PMID: 34907577 DOI: 10.1111/bcp.15180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/29/2021] [Accepted: 12/02/2021] [Indexed: 11/28/2022] Open
Abstract
AIM The direct oral anticoagulants (DOACs) are increasingly used for stroke prevention in atrial fibrillation (AF). However, little is known about the association between medication adherence, patient satisfaction and treatment knowledge. The objective was to determine patients' DOAC adherence and their treatment satisfaction over time. Furthermore, we respectively investigated possible associations of treatment satisfaction and treatment knowledge in relation to adherence. METHODS Longitudinal study conducted in AF patients hospitalized in 2019 in a tertiary university hospital. DOAC adherence, treatment satisfaction and knowledge were assessed with validated questionnaires. Mixed effects logistic regression was modelled to investigate the effect of both treatment satisfaction and knowledge on DOAC adherence over time. RESULTS In total, 164 patients participated of which 128 and 101 patients could be recontacted after a period of respectively 3 (first contact) and 6 months (second contact) to assess adherence and treatment satisfaction. Suboptimal adherence was observed in 40.6% of the patients after 3 months and in 42.6% after 6 months (p=0.78). There was no significant difference (p=0.29) in the total score for treatment satisfaction between the first (79.2%) and the second contact (80.6%). DOAC adherence was not affected by time (p=0.71) nor by total knowledge score (p=0.61) or treatment satisfaction score (p=0.34). Nonetheless, a strong correlation between treatment satisfaction and knowledge was found (p=0.004). CONCLUSION DOAC adherence was suboptimal. Treatment satisfaction and knowledge were not associated with DOAC adherence over a 6 month period. Knowledge gaps were identified that could be remediated through patient education and follow-up.
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Affiliation(s)
- Souad Moudallel
- Research Group Clinical Pharmacology and Clinical Pharmacy; Vrije Universiteit Brussel, Brussel, Belgium
| | - Sven van Laere
- Research Group of Biostatistics and Medical Informatics, Department of Public Health (GEWE), Vrije Universiteit Brussel, Brussel, Belgium
| | - Pieter Cornu
- Research Group Clinical Pharmacology and Clinical Pharmacy; Vrije Universiteit Brussel, Brussel, Belgium
| | - Alain Dupont
- Research Group Clinical Pharmacology and Clinical Pharmacy; Vrije Universiteit Brussel, Brussel, Belgium
| | - Stephane Steurbaut
- Research Group Clinical Pharmacology and Clinical Pharmacy; Vrije Universiteit Brussel, Brussel, Belgium
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13
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Lee YS, Oh YS, Choi EK, Chern AKC, Jiampo P, Chutinet A, Hanafy DA, Trivedi P, Zhai D. Patient perception and treatment convenience of dabigatran versus vitamin K antagonist when used for stroke prophylaxis in atrial fibrillation: Real-world Evaluation of Long-term Anticoagulant Treatment Experience (RE-LATE) study. Open Heart 2021; 8:openhrt-2021-001745. [PMID: 34857666 PMCID: PMC8640669 DOI: 10.1136/openhrt-2021-001745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Dabigatran is a direct thrombin inhibitor approved for stroke prophylaxis in patients with non-valvular atrial fibrillation (NVAF). Real-world data about patient preference, satisfaction and convenience in patients in Asia are not available. The study aimed to explore the perception of patients with newly diagnosed NVAF regarding dabigatran versus vitamin K antagonists (VKAs), when used for stroke prevention. Patients and methods This was a multinational, multicentre, non-interventional study involving 49 sites across 5 countries in South East Asia and South Korea where 934 patients newly diagnosed with NVAF were initiated on either dabigatran (N=591) or VKA (N=343). Data were collected at baseline and over two follow-up visits across 6 months. Treatment satisfaction and patient convenience were evaluated using the Perception on Anticoagulant Treatment Questionnaire-2 (PACT-Q2). Results The mean age of the patients was 65.9±10.4 years, and 64.2% were male. Mean CHA2DS2-VASc score was 2.4±1.5, and mean HAS-BLED score was 1.2±0.9. At baseline, patients initiated on dabigatran had higher stroke risk, bleeding risk, creatinine clearance and proportion of patients with concomitant illnesses compared with patients initiated on VKAs. Treatment convenience was perceived to be significantly better with dabigatran versus VKAs at visits 2 and 3 (p=0.0423 and 0.0287, respectively). Treatment satisfaction was significantly better with dabigatran compared with VKAs at visit 3 (p=0.0300). Conclusion In this study, dabigatran is associated with better patient perception in terms of treatment convenience and satisfaction compared with VKAs when used for stroke prevention in newly diagnosed NVAF patients from South East Asia and South Korea. Trial registration number NCT02849509. Plain language summary Patient satisfaction with dabigatran versus VKAs in South East Asia. Patients with atrial fibrillation are at high risk of stroke and require anticoagulants for stroke prevention. Two such anticoagulants are dabigatran and VKAs. We wanted to compare the extent of satisfaction and treatment convenience among newly diagnosed patients with atrial fibrillation from the South East Asian region when they were given either dabigatran or VKAs. Consenting patients filled out a standardised questionnaire called the PACT-Q2 over three visits after they were started on either dabigatran (591 patients) or VKAs (343 patients). We found that satisfaction and convenience were significantly higher when patients received dabigatran than when they received VKAs.
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Affiliation(s)
- Young-Soo Lee
- Department of Internal Medicine, Daegu Catholic University College of Medicine, Daegu, Republic of Korea
| | - Yong Seog Oh
- Department of Internal Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Panyapat Jiampo
- Department of Medicine, Bhumibol Adulyadej Hospital, Bangkok, Thailand
| | - Aurauma Chutinet
- Chulalongkorn Stroke Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Division of Neurology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Dicky Armein Hanafy
- Cardiology and Vascular Medicine, Pusat Jantung Nasional Harapan Kita, Jakarta, Indonesia.,Cardiology and Vascular Medicine, University of Indonesia Faculty of Medicine, Jakarta, Indonesia
| | | | - Dongmei Zhai
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut, USA
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14
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Caceres BA, Hickey KT, Bakken SB, Biviano AB, Garan H, Goldenthal IL, Koleck TA, Masterson-Creber R, Turchioe MR, Jia H. Mobile Electrocardiogram Monitoring and Health-Related Quality of Life in Patients With Atrial Fibrillation: Findings From the iPhone Helping Evaluate Atrial Fibrillation Rhythm Through Technology (iHEART) Study. J Cardiovasc Nurs 2021; 35:327-336. [PMID: 32015256 PMCID: PMC7299739 DOI: 10.1097/jcn.0000000000000646] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with high recurrence rates and poor health-related quality of life (HRQOL) but few effective interventions to improve HRQOL exist. OBJECTIVE The aim of this study was to examine the impact of the "iPhone Helping Evaluate Atrial Fibrillation Rhythm through Technology" (iHEART) intervention on HRQOL in patients with AF. METHODS We randomized English- and Spanish-speaking adult patients with AF to receive either the iHEART intervention or usual care for 6 months. The iHEART intervention used smartphone-based electrocardiogram monitoring and motivational text messages. Three instruments were used to measure HRQOL: the Atrial Fibrillation Effect on Quality of Life (AFEQT), the 36-item Short-Form Health survey, and the EuroQol-5D. We used linear mixed models to compare the effect of the iHEART intervention on HRQOL, quality-adjusted life-years, and AF symptom severity. RESULTS A total of 238 participants were randomized to the iHEART intervention (n = 115) or usual care (n = 123). Of the participants, 77% were men and 76% were white. More than half (55%) had an AF recurrence. Both arms had improved scores from baseline to follow-up for AFEQT and AF symptom severity scores. The global AFEQT score improved 18.5 and 11.2 points in the intervention and control arms, respectively (P < .05). There were no statistically significant differences in HRQOL, quality-adjusted life-years, or AF symptom severity between groups. CONCLUSIONS We found clinically meaningful improvements in AF-specific HRQOL and AF symptom severity for both groups. Additional research with longer follow-up should examine the influence of smartphone-based interventions for AF management on HRQOL and address the unique needs of patients diagnosed with different subtypes of AF.
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15
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Piersma‐Wichers M, Elling T, de Vries‐Bots AMB, Kooistra HAM, Meijer K. Convenience and satisfaction in direct oral anticoagulant-treated patients with atrial fibrillation. Res Pract Thromb Haemost 2021; 5:e12577. [PMID: 34430791 PMCID: PMC8371341 DOI: 10.1002/rth2.12577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/18/2021] [Accepted: 07/12/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Direct oral anticoagulants (DOACs) are the preferred anticoagulants for thromboprophylaxis in atrial fibrillation. We aimed to identify determinants of quality of life related to DOAC treatment to optimize DOAC treatment convenience and satisfaction. METHODS We conducted a cross-sectional study in DOAC users. DOAC treatment-related convenience and satisfaction were measured by Perception of Anticoagulant Treatment Questionnaire. Higher scores are more favorable (range, 0-100). Patient-reported outcome measures and drug- and organization-related factors were collected. Multiple regression analyses were used to evaluate the association between these factors (ie, exposure variables) and DOAC treatment-related convenience and treatment satisfaction (ie, outcome variables). RESULTS Of 1598 patients invited, 1035 responded, and 962 were included. The median convenience score was 98.1 (94.2-100.0), mean satisfaction score 66.5± 14.9. Twenty-four percent felt not well informed at the start of DOAC; 6.9% did not know who to turn to with questions. Multiple regression analyses showed that lacking sense of security, the predefined composite of receiving insufficient information at start of DOAC and/or not knowing who to turn to with questions was associated with lower convenience (regression coefficient, -1.29; 95% confidence interval [CI], -2.16 to -0.41). Bleeding, gastrointestinal complaints, and lower medication adherence were also associated with lower convenience. Missing sense of security (regression coefficient -6.59; 95% CI, -8.94 to -4.24) and bleeding without consultation were associated with lower treatment satisfaction. CONCLUSIONS Accessible interventions to improve DOAC care could be providing more instruction at treatment initiation and ensuring that patients know who to contact in case of problems.
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Affiliation(s)
- Margriet Piersma‐Wichers
- Department of HaematologyUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
- Certe Thrombosis Service GroningenGroningenthe Netherlands
| | - Tessa Elling
- Department of HaematologyUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | | | - Hilde A. M. Kooistra
- Department of HaematologyUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Karina Meijer
- Department of HaematologyUniversity of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
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16
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Fedorov K, Goel S, Kushnir M, Billett HH. Thrombosis in myeloproliferative neoplasms: Treatment outcomes of direct oral anticoagulants and vitamin K antagonists. Res Pract Thromb Haemost 2021; 5:e12574. [PMID: 34532628 PMCID: PMC8440942 DOI: 10.1002/rth2.12574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Patients with myeloproliferative neoplasms (MPNs), such as polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), are at an increased risk of recurrent thromboembolic events (TEs) and hemorrhagic complications. Anticoagulation with vitamin K antagonists (VKAs) had been the standard of care until the recent US Food and Drug Administration approval of direct oral anticoagulants (DOACs) for treatment of cancer-associated thrombosis. However, since patients with MPNs were underrepresented in large studies, the use of DOACs in patients with MPN-associated thrombosis remains understudied. OBJECTIVES The primary objective of this study was to establish the incidence of recurrent TEs and hemorrhagic complications in patients with MPN-associated thrombosis treated with DOACs versus VKAs as first-line therapy. METHODS Data from 30 patients ≥18 years old with established diagnoses of PV or ET who were treated with either DOACs or VKAs as the first-line anticoagulant for arterial and/or venous thrombosis were reviewed to determine the incidence of recurrent TEs as well as hemorrhagic complications. RESULTS Nineteen patients were treated with DOACs, and 11 were treated with VKAs. Of those on DOACs, 1 had a recurrent thrombosis, and 4 had bleeding events. Of the 11 patients treated with VKAs, 1 had a recurrent thrombotic event, and 1 had a bleeding event. CONCLUSION Our data did not demonstrate a significant difference in recurrent TEs or bleeding events in patients with MPN-associated thrombosis anticoagulated with either DOACs or VKAs.
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Affiliation(s)
- Kateryna Fedorov
- Division of HematologyDepartment of OncologyMontefiore Medical Center and the Albert Einstein College of MedicineBronxNYUSA
| | - Swati Goel
- Division of HematologyDepartment of OncologyMontefiore Medical Center and the Albert Einstein College of MedicineBronxNYUSA
| | - Margarita Kushnir
- Division of HematologyDepartment of OncologyMontefiore Medical Center and the Albert Einstein College of MedicineBronxNYUSA
| | - Henny H. Billett
- Division of HematologyDepartment of OncologyMontefiore Medical Center and the Albert Einstein College of MedicineBronxNYUSA
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17
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Fong AYY, Tiong LL, Tan SSN, Geruka D, Apil GG, Choo CW, Ong TK. Effect of Dabigatran on Clotting Time in the Clotpro Ecarin Clotting Assay: A Prospective, Single-Arm, Open-Label Study. Clin Appl Thromb Hemost 2021; 26:1076029620972473. [PMID: 33284050 PMCID: PMC7724398 DOI: 10.1177/1076029620972473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Routine coagulation tests do not enable rapid, accurate determination of direct
oral anticoagulant (DOAC) therapy. The ecarin clotting assay (ECA), performed on
the ClotPro viscoelastic testing device, may enable sensitive and specific
detection of dabigatran. We assessed the association between trough plasma
dabigatran concentration and clotting time (CT) in the ClotPro ECA, in patients
with non-valvular atrial fibrillation (NVAF). Each patient provided a single
venous blood sample, ∼1 hour before dabigatran dosing. The study included 118
patients, of whom 64 were receiving dabigatran 110 mg twice daily and 54 were
receiving 150 mg twice daily. ECA CT was moderately correlated with trough
plasma dabigatran concentration (r = 0.80, p < 0.001).
Slight trends toward increased plasma dabigatran concentration and prolonged ECA
CT were apparent with 150 mg versus the 110 mg dose (differences not
statistically significant). Individuals with creatinine clearance below 50
mL/minute had significantly higher plasma dabigatran concentrations and
significantly prolonged ECA CT versus those with creatinine clearance ≥50
mL/minute. In conclusion, this preliminary study has demonstrated that CT in the
ClotPro ECA reflects the plasma concentration of dabigatran in patients with
NVAF. The ECA could potentially be used to assess the impact of dabigatran on a
patient’s coagulation status.
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Affiliation(s)
- Alan Yean Yip Fong
- Clinical Research Center, 58986Sarawak General Hospital, Institute for Clinical Research, National Institutes of Health, Shah Alam, Malaysia.,Department of Cardiology, Sarawak Heart Center, Kota Samarahan, Sarawak, Malaysia
| | - Lee Len Tiong
- Clinical Research Center, 58986Sarawak General Hospital, Institute for Clinical Research, National Institutes of Health, Shah Alam, Malaysia
| | - Shirley Siang Ning Tan
- Clinical Research Center, 58986Sarawak General Hospital, Institute for Clinical Research, National Institutes of Health, Shah Alam, Malaysia.,Department of Pharmacy, 58986Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Dominic Geruka
- Clinical Research Center, 58986Sarawak General Hospital, Institute for Clinical Research, National Institutes of Health, Shah Alam, Malaysia
| | - Gerald Grino Apil
- Clinical Research Center, 58986Sarawak General Hospital, Institute for Clinical Research, National Institutes of Health, Shah Alam, Malaysia
| | - Chee Wei Choo
- Clinical Research Center, 58986Sarawak General Hospital, Institute for Clinical Research, National Institutes of Health, Shah Alam, Malaysia
| | - Tiong Kiam Ong
- Department of Cardiology, Sarawak Heart Center, Kota Samarahan, Sarawak, Malaysia
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18
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Buck J, Fromings Hill J, Martin A, Springate C, Ghosh B, Ashton R, Lee G, Orlowski A. Reasons for discontinuing oral anticoagulation therapy for atrial fibrillation: a systematic review. Age Ageing 2021; 50:1108-1117. [PMID: 33693496 PMCID: PMC8839858 DOI: 10.1093/ageing/afab024] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia and can lead to significant comorbidities and mortality. Persistence with oral anticoagulation (OAC) is crucial to prevent stroke but rates of discontinuation are high. This systematic review explored underlying reasons for OAC discontinuation. Methods A systematic review was undertaken to identify studies that reported factors influencing discontinuation of OAC in AF, in 11 databases, grey literature and backwards citations from eligible studies published between 2000 and 2019. Two reviewers independently screened titles, abstracts and papers against inclusion criteria and extracted data. Study quality was appraised using Gough’s weight of evidence framework. Data were synthesised narratively. Results Of 6,619 sources identified, 10 full studies and 2 abstracts met the inclusion criteria. Overall, these provided moderate appropriateness to answer the review question. Four reported clinical registry data, six were retrospective reviews of patients’ medical records and two studies reported interviews and surveys. Nine studies evaluated outcomes relating to dabigatran and/or warfarin and three included rivaroxaban (n = 3), apixaban (n = 3) and edoxaban (n = 1). Bleeding complications and gastrointestinal events were the most common factors associated with discontinuation, followed by frailty and risk of falling. Patients’ perspectives were seldom specifically assessed. Influence of family carers in decisions regarding OAC discontinuation was not examined. Conclusion The available evidence is derived from heterogeneous studies with few relevant data for the newer direct oral anticoagulants. Reasons underpinning decision-making to discontinue OAC from the perspective of patients, family carers and clinicians is poorly understood.
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Affiliation(s)
- Jackie Buck
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Julia Fromings Hill
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | | | | | | | - Rachel Ashton
- Imperial College Health Partners, London NW1 2FB, UK
| | - Gerry Lee
- Adult Nursing, James Clerk Maxwell Building, King’s College London, London SE1 8WA, UK
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19
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Vinereanu D, Napalkov D, Bergler-Klein J, Benczur B, Ciernik M, Gotcheva N, Medvedchikov A, Põder P, Simić D, Skride A, Tang W, Trusz-Gluza M, Vesely J. Patient perceptions of anticoagulant treatment with dabigatran or a vitamin K antagonist for stroke prevention in atrial fibrillation according to region and age: an exploratory analysis from the RE-SONANCE study. J Thromb Thrombolysis 2021; 52:1195-1206. [PMID: 33929686 PMCID: PMC8605976 DOI: 10.1007/s11239-021-02450-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/28/2022]
Abstract
Background The oral anticoagulant dabigatran offers an effective alternative to vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF), yet patient preference data are limited. The prospective observational RE-SONANCE study demonstrated that patients with AF, newly initiated on dabigatran, or switching to dabigatran from long-term VKA therapy, reported improved treatment convenience and satisfaction compared with VKA therapy. This pre-specified sub-study aimed to assess the impact of country and age on patients’ perceptions of dabigatran or VKA therapy in AF. Methods RE-SONANCE was an observational, prospective, multi-national study (NCT02684981) that assessed treatment satisfaction and convenience in patients switching from VKAs to dabigatran (Cohort A), or newly diagnosed with AF receiving dabigatran or VKAs (Cohort B), using the PACT-Q questionnaire. Pre-specified exploratory outcomes: variation in PACT-Q2 scores by country and age (< 65, 65 to < 75, ≥ 75 years) (both cohorts); variation in PACT-Q1 responses at baseline by country and age (Cohort B). Results Patients from 12 countries (Europe/Israel) were enrolled in Cohort A (n = 4103) or B (n = 5369). In Cohort A, mean (standard deviation) PACT-Q2 score increase was highest in Romania (convenience: 29.6 [23.6]) and Hungary (satisfaction: 26.0 [21.4]) (p < 0.001). In Cohort B, mean (standard error) increase in PACT-Q2 scores between dabigatran and VKAs was highest in Romania (visit 3: 29.0 [1.3]; 24.5 [0.9], p < 0.001). Mean PACT-Q2 score increase by age (all p < 0.001) was similar across ages. PACT-Q1 responses revealed lowest expectations of treatment success in Romania and greatest concerns about payment in Estonia, Latvia, and Romania, but were similar across ages. Conclusions Treatment satisfaction and convenience tended to favor dabigatran over VKAs. Regional differences in treatment expectations exist across Europe. Trial and clinical registry Trial registration number: ClinicalTrials.gov NCT02684981. Trial registration date: February 18, 2016. Supplementary Information The online version contains supplementary material available at 10.1007/s11239-021-02450-2.
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Affiliation(s)
- Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Splaiul Independentei 169, 050078, Bucharest, Romania.
| | - Dmitry Napalkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Jutta Bergler-Klein
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Bela Benczur
- Balassa Janos County Hospital, Szekszárd, Hungary
| | | | | | | | - Pentti Põder
- North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - Dragan Simić
- Clinic of Cardiology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andris Skride
- Pauls Stradins Clinical University Hospital, Riga Stradinš University, Riga, Latvia
| | - Wenbo Tang
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA
| | | | - Jiří Vesely
- Faculty of Medicine in Hradec Kralove, Charles University and Edumed s.r.o, Broumov, Czech Republic
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20
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Harrison SL, Akpan A, Lip GYH. Frailty and cognitive impairment are not reasons to withhold anticoagulation in people with atrial fibrillation but screening could guide management. J Am Geriatr Soc 2021; 69:1807-1810. [PMID: 33893638 DOI: 10.1111/jgs.17142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Asangaedem Akpan
- Institute of Life Course and Medical Sciences & Liverpool University Hospital NHS FT, Liverpool, UK.,Institute of Health, University of Cumbria, Carlisle, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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21
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Lee CW, Liu ME, Lee TM, Chang RY, Huang CY, Hu YF, Yeh HI. Patient satisfaction with dabigatrean and warfarin for stroke prevention in atrial fibrillation: Taiwan PASSION study. J Chin Med Assoc 2021; 84:375-382. [PMID: 33784265 DOI: 10.1097/jcma.0000000000000496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patient satisfaction with oral anticoagulant (OAC) therapy is an important metric of care quality and has been associated with higher medication persistence. Among OACs, dabigatran has been shown to be non-inferior to vitamin K antagonists (VKAs) with increased ease of use for stroke prevention in patients with atrial fibrillation (AF). In this study, we sought to evaluate the expectations, convenience, and satisfaction of Taiwanese AF patients on dabigatran and VKA therapies as well as associated clinical outcomes. METHODS Patients with AF (paroxysmal, persistent, or permanent) receiving OAC medication from outpatient facilities were enrolled in 24 hospitals across Taiwan. Cohort A consisted of 139 patients switched from VKA to dabigatran, while cohort B was comprised of 1113 patients on newly initiated OAC therapy (VKA, 54). The Perception of Anticoagulant Treatment Questionnaire was distributed, and responses on a five-point Likert scale were aggregated and analyzed across demographic groups. RESULTS In cohort A, convenience and satisfaction scores continued to increase at follow-up and significantly higher, compared to baseline, but both treatments scored similarly in cohort B. In cohort B, the two highest expectation scores were that the OAC would be "easy to take" and could be "taken independently." On the other hand, the patients were relatively less concerned about the side effects and cost of therapy before taking the OAC. For dabigatran-receiving patients, there were 1.1 stroke-related events per 100 patient-years and 3.0 bleeding-related events per 100 patient-years. CONCLUSION In Taiwanese patients with AF and initially treated with VKA, switched to dabigatran resulted in higher convenience and treatment satisfaction. For those patients on newly initiated OAC treatment, VKA and dabigatran convenience and satisfaction scores were similar.
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Affiliation(s)
- Chun-Wei Lee
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, MacKay Medical College, New Taipei City, Taiwan, ROC
- MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan, ROC
- Cardiovascular Division, Landseed International Hospital, Taoyuan, ROC
| | - Ming-En Liu
- Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan, ROC
| | - Tsung-Ming Lee
- Cardiovascular Institute, An Nan Hospital, China Medical University, Tainan, Taiwan, ROC
- Department of Medicine, China Medical University, Taichung, Taiwan, ROC
| | - Rei-Yeuh Chang
- Division of Cardiology, Chia-Yi Christian Hospital, Chiayi, Taiwan, ROC
| | - Chun-Yao Huang
- Division of Cardiology, Taipei Medical University Hospital, Taipei, Taiwan, ROC
| | - Yu-Feng Hu
- Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hung-I Yeh
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, MacKay Medical College, New Taipei City, Taiwan, ROC
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22
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Moudallel S, van den Bemt BJF, Zwikker H, de Veer A, Rydant S, Dijk LV, Steurbaut S. Association of conflicting information from healthcare providers and poor shared decision making with suboptimal adherence in direct oral anticoagulant treatment: A cross-sectional study in patients with atrial fibrillation. PATIENT EDUCATION AND COUNSELING 2021; 104:155-162. [PMID: 32622691 DOI: 10.1016/j.pec.2020.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess direct oral anticoagulant (DOAC) adherence and to determine possible determinants for suboptimal adherence in Dutch patients with atrial fibrillation (AF). METHODS Cross-sectional study of DOAC users who completed a self-reported questionnaire. Adherence was measured with Morisky8-item Medication Adherence Scale (MMAS-8). Logistic regression analysis was conducted to investigate determinants affecting adherence. RESULTS 398 DOAC users completed the questionnaire (mean age 70.6 ± 9.2years). Approximately one in four patients had suboptimal adherence (MMAS-8 < 8). Multivariable analysis showed that patients who felt to have received conflicting information about the treatment, patients with higher educational level and patients who were not sufficiently involved in the treatment choice had a higher odds of suboptimal adherence. CONCLUSION DOAC adherence was suboptimal. Conflicting information received from different healthcare providers (HCPs), lack of shared decision making and the patients' educational level were determinants negatively affecting DOAC adherence. PRACTICE IMPLICATIONS Efforts towards identifying suboptimally adherent DOAC patients are needed since they are at higher risk to develop thromboembolic events. Adherence counselling should be systematically and repeatedly encouraged and shared decision making should become more mainstream. Moreover, reinforced education of both patients and HCPs combined with interprofessional collaboration are potential solutions to prevent knowledge gaps and communication of conflicting information.
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Affiliation(s)
- Souad Moudallel
- Vrije Universiteit Brussel, Faculty of Medicine and Pharmacy, Centre for Pharmaceutical Research (CePhar), Brussels, Belgium; Department of Clinical Pharmacology and Pharmacotherapy, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium.
| | - Bart J F van den Bemt
- Department of Rheumatology and Pharmacy, Sint Maartenskliniek, Nijmegen, the Netherlands
| | - Hanneke Zwikker
- Dutch Institute for Rational Use of Medicine (IVM), Utrecht, the Netherlands
| | - Anne de Veer
- Department of Cardiology, St-Antonius Hospital, Nieuwegein, the Netherlands
| | - Silas Rydant
- Vrije Universiteit Brussel, Faculty of Medicine and Pharmacy, Centre for Pharmaceutical Research (CePhar), Brussels, Belgium; KAVA, Royal Pharmaceutical Society of Antwerp, Antwerp, Belgium
| | - Liset van Dijk
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Stephane Steurbaut
- Vrije Universiteit Brussel, Faculty of Medicine and Pharmacy, Centre for Pharmaceutical Research (CePhar), Brussels, Belgium; Department of Clinical Pharmacology and Pharmacotherapy, Universitair Ziekenhuis (UZ) Brussel, Brussels, Belgium
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23
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Rahman MK, Bhuiyan MA, Zailani S. Healthcare Services: Patient Satisfaction and Loyalty Lessons from Islamic Friendly Hospitals. Patient Prefer Adherence 2021; 15:2633-2646. [PMID: 34866903 PMCID: PMC8633710 DOI: 10.2147/ppa.s333595] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/20/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The study has aimed to investigate the Muslim patient's psychological factors related to healthcare services that influence their loyalty intention for further treatment at private hospitals in Malaysia. METHODS Data were collected from private hospitals in Klang Valley. A total of 379 responses from patients were analysed using the structural equation modelling approach. RESULTS The findings revealed that administrative behaviour, nurse's services and Shariah amenities have a highly significant impact on satisfaction. The healthcare technicality, hospital environment and physician's services have a significant relationship with patient satisfaction. Patient satisfaction has a significant impact on patient loyalty to healthcare services at the hospital. Administrative behaviour, physicians' services and healthcare technicality have a direct and positive relationship with loyalty intention, while Shariah amenity has a negative significant relationship with loyalty. CONCLUSION The results have important implications for product development and managerial considerations in hospitals. Service providers need to be mindful that all aspects, including Shariah amenities and generic healthcare service delivery, are important and need to be balanced and delivered satisfactorily to ensure customer satisfaction.
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Affiliation(s)
- Muhammad Khalilur Rahman
- Faculty of Entrepreneurship and Business, Universiti Malaysia Kelantan, Pengkalan Chepa, 16100, Malaysia
| | - Miraj Ahmed Bhuiyan
- School of Economics, Guangdong University of Finance and Economics, Guangzhou, Guangdong, People’s Republic of China
- Correspondence: Miraj Ahmed Bhuiyan School of Economics, Guangdong University of Finance and Economics, 21 Luntou Road, Guangzhou, Guangdong, People’s Republic of China Email
| | - Suhaiza Zailani
- Faculty of Business and Accountancy, University of Malaya, Kuala Lumpur, Malaysia
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24
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Magnocavallo M, Bellasi A, Mariani MV, Fusaro M, Ravera M, Paoletti E, Di Iorio B, Barbera V, Della Rocca DG, Palumbo R, Severino P, Lavalle C, Di Lullo L. Thromboembolic and Bleeding Risk in Atrial Fibrillation Patients with Chronic Kidney Disease: Role of Anticoagulation Therapy. J Clin Med 2020; 10:jcm10010083. [PMID: 33379379 PMCID: PMC7796391 DOI: 10.3390/jcm10010083] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/17/2022] Open
Abstract
Atrial fibrillation (AF) and chronic kidney disease (CKD) are strictly related; several independent risk factors of AF are often frequent in CKD patients. AF prevalence is very common among these patients, ranging between 15% and 20% in advanced stages of CKD. Moreover, the results of several studies showed that AF patients with end stage renal disease (ESRD) have a higher mortality rate than patients with preserved renal function due to an increased incidence of stroke and an unpredicted elevated hemorrhagic risk. Direct oral anticoagulants (DOACs) are currently contraindicated in patients with ESRD and vitamin K antagonists (VKAs), remaining the only drugs allowed, although they show numerous critical issues such as a narrow therapeutic window, increased tissue calcification and an unfavorable risk/benefit ratio with low stroke prevention effect and augmented risk of major bleeding. The purpose of this review is to shed light on the applications of DOAC therapy in CKD patients, especially in ESRD patients.
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Affiliation(s)
- Michele Magnocavallo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.M.); (M.V.M.); (P.S.); (C.L.)
| | - Antonio Bellasi
- Department of Research, Innovation and Brand Reputation, ASST-Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.M.); (M.V.M.); (P.S.); (C.L.)
| | - Maria Fusaro
- National Council of Research, Institute of Clinical Physiology, 56124 Pisa, Italy;
| | - Maura Ravera
- Nefrologia, Dialisi e Trapianto, Policlinico San Martino, 16132 Genova, Italy; (M.R.); (E.P.)
| | - Ernesto Paoletti
- Nefrologia, Dialisi e Trapianto, Policlinico San Martino, 16132 Genova, Italy; (M.R.); (E.P.)
| | - Biagio Di Iorio
- Department of Nephrology and Dialysis, Moscati Hospital, 83100 Avellino, Italy;
| | - Vincenzo Barbera
- Department of Nephrology and Dialysis, Parodi-Delfino Hospital, 00034 Colleferro, Italy;
| | | | - Roberto Palumbo
- Department of Nephrology and Dialysis, Sant’Eugenio Hospital, 00144 Rome, Italy;
| | - Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.M.); (M.V.M.); (P.S.); (C.L.)
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, 00161 Rome, Italy; (M.M.); (M.V.M.); (P.S.); (C.L.)
| | - Luca Di Lullo
- Department of Nephrology and Dialysis, Parodi-Delfino Hospital, 00034 Colleferro, Italy;
- Correspondence: ; Fax: +39-06-972233213
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25
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Varona JF, Seguí-Ripoll JM, Lozano-Duran C, Cuadrado-Gómez LM, Montagud-Moncho JB, Ramos-Guerrero A, Mirete-Ferrer JC, Donado E, García-Alegría J. Health-related quality of life in nonvalvular atrial fibrillation patients with controlled or uncontrolled anticoagulation status. Health Qual Life Outcomes 2020; 18:383. [PMID: 33308246 PMCID: PMC7731734 DOI: 10.1186/s12955-020-01563-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/14/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There is a dearth of evidence regarding Health-Related Quality of Life (HRQoL) in nonvalvular atrial fibrillation (NVAF) patients undergoing oral anticoagulation therapy. Our objective was to describe HRQoL in NVAF patients on oral anticoagulation, focusing on uncontrolled patients on vitamin K antagonists (VKAs) versus controlled patients on VKAs or non-vitamin K antagonist oral anticoagulants (NOACs), in a real-world setting. Additionally, we assessed the clinical characteristics of patients with uncontrolled anticoagulation. METHODS An observational, multicentre, and cross-sectional study, enrolling 38 Spanish Hospitals' Internal Medicine Departments. HRQoL was assessed using the validated Spanish version of the Sawicki questionnaire. High self-perceived HRQoL was indicated by high scores in the general treatment satisfaction and self-efficacy dimensions, and by low scores in the strained social network, daily hassles and distress dimensions. RESULTS Five hundred and one patients were included for assessment. Mean scores ± SD were closer to a high perceived HRQoL in controlled than uncontrolled patients for the five dimensions of the questionnaire: 4.9 ± 1.0 versus 3.6 ± 1.3 for general treatment satisfaction; 4.3 ± 1.0 versus 3.6 ± 1.0 for self-efficacy, 3.1 ± 0.9 versus 3.9 ± 1.1 for strained social network, 2.1 ± 0.8 versus 3.0 ± 1.0 for daily hassles and 1.8 ± 0.9 versus 2.6 ± 1.2 for distress. CONCLUSIONS HRQoL in patients with controlled anticoagulant status treated with NOACs or VKAs was better than in patients with uncontrolled anticoagulant status. This seems to indicate that anticoagulation control status influences perception of HRQoL, highlighting the importance of its evaluation when assessing HRQoL in NVAF patients.
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Affiliation(s)
| | - José Miguel Seguí-Ripoll
- Hospital San Juan de Alicante, San Juan de Alicante, Alicante Spain
- Department of Clinical Medicine, Miguel Hernández University, Elche, Alicante Spain
| | | | | | | | | | | | - Esther Donado
- Boehringer-Ingelheim, Sant Cugat del Vallés, Barcelona Spain
| | | | - the REQUOL Study Group
- Hospital HM Montepríncipe, Boadilla del Monte, Madrid Spain
- Hospital San Juan de Alicante, San Juan de Alicante, Alicante Spain
- Department of Clinical Medicine, Miguel Hernández University, Elche, Alicante Spain
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid Spain
- Hospital Francesc de Borja, Gandía, Valencia Spain
- Hospital San Juan de Dios del Aljarafe, Bormujos, Seville Spain
- Hospital de Torrevieja, Torrevieja, Alicante Spain
- Boehringer-Ingelheim, Sant Cugat del Vallés, Barcelona Spain
- Hospital Costa del Sol, A-7, Km 187, 29603 Marbella, Malaga Spain
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26
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Katerenchuk V, Duarte GS, Martins E Pereira G, Fernandes RM, Ferreira JJ, Pinto FJ, Costa J, Caldeira D. Satisfaction of Patients with Nonvitamin K Anticoagulants Compared to Vitamin K Antagonists: a Systematic Review and Meta-analysis. Thromb Haemost 2020; 121:366-382. [PMID: 33160289 DOI: 10.1055/s-0040-1716752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To undertake a systematic review and meta-analysis to assess the satisfaction of patients receiving nonvitamin K anticoagulants (NOACs), compared with vitamin K antagonists (VKAs). METHODS We searched CENTRAL, MEDLINE, Embase, and Clinicaltrials.gov for randomized controlled trials (RCTs) and observational studies. Two reviewers screened, extracted, and appraised data independently. We pooled data using a random-effects model. Outcome included treatment satisfaction, which was assessed by scores of Duke Anticoagulation Satisfaction Scale (DASS), Anticlot Treatment Scale (ACTS), Perception of Anticoagulant Treatment Questionnaire 2 (PACT-Q2), or Treatment Satisfaction Questionnaire for Medication version II (TSQM-VII) and their domains reported with 95% confidence intervals (95% CIs). We followed MOOSE and PRISMA guidelines. RESULTS We included four RCTs and 16 observational studies, enrolling 18,684 participants overall. Compared with VKAs, treatment with NOACs improved the ACTS Burdens score by 4.21 points (95% CI: 2.99-5.43, I 2 = 95%, combined n = 6,180), and ACTS Benefits by 0.49 points (95% CI: 0.18-0.81, I 2 = 85%, combined n = 6,171). Switching from VKAs to NOACs improved the ACTS Burdens score by 5.33 points (95% CI: 3.53-7.14, combined n = 3,097). Compared with VKAs, treatment with NOACs improved the TSQM-VII Global Satisfaction score by 6.86 points (95% CI: 3.00-10.73, combined n = 5,535). CONCLUSION In patients with nonvalvular atrial fibrillation or venous thromboembolism, NOAC treatment is associated with greater satisfaction compared with VKAs. The switch from VKAs to NOACs was associated with improved patients' satisfaction. These effects were largely due to a lower degree of treatment burden with NOAC treatment.
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Affiliation(s)
| | - Gonçalo S Duarte
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa (CAML), Lisboa, Portugal
| | | | - Ricardo M Fernandes
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Serviço de Pediatria, Hospital de Santa Maria - Centro Hospitalar Universitário de Lisboa Norte (CHLN), Centro Académico de Medicina de Lisboa, (CAML) Lisboa, Portugal
| | - Joaquim J Ferreira
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,CNS - Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Fausto J Pinto
- Serviço de Cardiologia, Hospital de Santa Maria-CHLN, CAML, Centro Cardiovascular da Universidade de Lisboa - CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - João Costa
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa (CAML), Lisboa, Portugal
| | - Daniel Caldeira
- Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,Serviço de Cardiologia, Hospital de Santa Maria-CHLN, CAML, Centro Cardiovascular da Universidade de Lisboa - CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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27
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Ivany E, Lane DA. Patient Satisfaction: A Key Component in Increasing Treatment Adherence and Persistence. Thromb Haemost 2020; 121:255-257. [PMID: 33124024 DOI: 10.1055/s-0040-1718734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Elena Ivany
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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28
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Ng DLC, Malik NMBA, Chai CS, Goh GMKC, Tan SB, Bee PC, Gan GG, Said AB. Time in therapeutic range, quality of life and treatment satisfaction of patients on long-term warfarin for non-valvular atrial fibrillation: a cross-sectional study. Health Qual Life Outcomes 2020; 18:347. [PMID: 33081816 PMCID: PMC7576864 DOI: 10.1186/s12955-020-01600-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/13/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The use of warfarin in patients with non-valvular atrial fibrillation (NVAF) can be challenging. In this study, we evaluate the time in therapeutic range (TTR), health-related quality of life (HRQoL) and treatment satisfaction of patients on long-term warfarin for NVAF. The HRQoL and treatment satisfaction were compared based on the TTR. METHODS A cross-sectional study was conducted among patients on warfarin for NVAF who attended the anticoagulant clinic of a tertiary cardiology referral center in Sarawak from 1st June 2018 to 31st May 2019. Patients' TTR was calculated by using Rosendaal technique, while their HRQoL and treatment satisfaction were assessed by using Short Form 12 Health Survey version 2 (SF12v2) and Duke Anticoagulant Satisfaction Scale (DASS), respectively. RESULTS A total of 300 patients were included, with mean TTR score of 47.0 ± 17.3%. The physical component summary (PCS) and mental component summary (MCS) score of SF-12v2 were 47.0 ± 9.0 and 53.5 ± 9.6, respectively. The total score for DASS was 55.2 ± 21.3, while the score for limitations (L), hassles and burdens (H&B) and positive psychological impacts (PPI) were 18.0 ± 10.0, 15.6 ± 9.1 and 21.6 ± 5.9, respectively. Seventy-three (24.3%) patients had good TTR (≥ 60%), with mean of 70.2 ± 8.7%; while 227 (75.5%) patients with poor TTR had significantly lower mean of 39.5 ± 11.9% (p = 0.006). There was no significant difference in the score of PCS (p = 0.150), MCS (p = 0.919) and each domain of SF-12v2 (p = 0.184-0.684) between good and poor TTR, except for social functioning (p = 0.019). The total DASS score was also not significantly different between group (p = 0.779). Similar non-significant difference was also reported in all the DASS sub dimensions (p = 0.502-0.699). CONCLUSIONS Majority of the patients on long-term warfarin for NVAF in the current study have poor TTR. Their HRQoL and treatment satisfaction are independent of their TTR. Achieving a good TTR do not compromise the HRQoL and treatment satisfaction. Therefore, appropriate measures should be taken to optimise INR control, failing which direct oral anticoagulant therapy should be considered.
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Affiliation(s)
- Diana-Leh-Ching Ng
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Natasya Marliana Bt Abdul Malik
- Department of Nursing, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Chee-Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Greta-Miranda-Kim-Choo Goh
- Department of Nursing, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Seng-Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ping-Chong Bee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Gin-Gin Gan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Asri B Said
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.
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Zuo K, Liu X, Wang P, Jiao J, Han C, Liu Z, Yin X, Li J, Yang X. Metagenomic data-mining reveals enrichment of trimethylamine-N-oxide synthesis in gut microbiome in atrial fibrillation patients. BMC Genomics 2020; 21:526. [PMID: 32731896 PMCID: PMC7391570 DOI: 10.1186/s12864-020-06944-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/24/2020] [Indexed: 12/12/2022] Open
Abstract
Background The gut bacteria-derived metabolite trimethylamine-N-oxide (TMAO) has been discussed in various cardiometabolic diseases. However, evidence characterizing the microbial population responsible for TMAO accumulation in patients with atrial fibrillation (AF), an increasingly prevalent arrhythmia, is yet lacking. In order to understand the key gut microorganisms that produce TMAO in AF, trimethylamine (TMA)-synthesis enzymes and metabolic pathways, as well as the potential TMA-producers in gut microbiome were assessed based on metagenomic data-mining in a northern Chinese cohort consisting of 50 non-AF controls and 50 patients with different types of AF. Results Compared to the control subjects, AF patients showed a marked increase in the microbial genes underlying TMA formation in the gut, which included 12 potential TMA-synthesis functional orthologs and 1 module. The specific bacterial genes, including choline-TMA lyase, carnitine monooxygenase, glycine betaine reductase, and TMAO reductase, were elevated in the gut of AF patients. Furthermore, 16 genera were assigned and significantly correlated with TMA-enzymatic genes, where 9 genera were remarkably enriched in the gut communities of AF patients. Neither of these TMA-synthesis pathways nor the microbial players showed a significant discrepancy between different types of AF in the current cohort. These gut microbes might participate in the formation of TMA by activating the key TMA-synthesis enzymes and contributing to the functional pathways in AF patients. Conclusions The present study provides an in-depth insight into the potential bacteria and metabolic pathways involved in TMA production in the gut of AF patients. These findings emphasize a key role of the gut bacteria in driving TMAO formation during AF pathogenesis, thereby indicating its therapeutic potential as an intervention strategy of AF by targeting TMA-synthesis pathways and dysbiotic gut microbiota.
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Affiliation(s)
- Kun Zuo
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Xiaoqing Liu
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Pan Wang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Jie Jiao
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Chunming Han
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Zheng Liu
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Xiandong Yin
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China
| | - Jing Li
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China.
| | - Xinchun Yang
- Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China.
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Ostrowka C, Journeau L, Plaisance L, Poenou G, Mecherour SE, Helfer H, Mahé I. Educational diagnosis of patients under oral anticoagulant therapy: Development of a 4-category patient profiling score based on a retrospective study and prospective analysis. JOURNAL DE MÉDECINE VASCULAIRE 2020; 45:184-191. [PMID: 32571558 DOI: 10.1016/j.jdmv.2020.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Oral anticoagulants are used in numerous pathologies and their consumption is growing. However, to prevent their occurrence, their use should be supervised and the patients educated. Patients vary in understanding and compliance. Therefore, it seems necessary to standardize educational diagnosis with a patient profiling score to adapt therapeutic education to the individual patient profile. METHOD A retrospective study based on observation of consecutive patients treated by an oral anticoagulant therapy and involved in a therapeutic education program conducted between October 2014 and December 2015. A 12-item questionnaire distinguished 4 profiles based on the educational diagnosis. In a prospective double-blind study including consecutive patients with an indication to anticoagulants and admitted to the Internal Medicine department of the Louis-Mourier Hospital (AP-HP, University of Paris), the patient's profile defined by a clinician using the questionnaire was compared to the one defined by the Therapeutic Education Leader after standardized educational diagnosis. RESULTS The questionnaire was tested prospectively in 53 patients, 26 of which had also a complete therapeutic education by the TEP leader. In any case, the assessment assisted by the questionnaire succeeded in identifying the patient profile, as determined by the therapeutic education specialist. CONCLUSION The present questionnaire helps identify different patient profiles and therefore standardize educational diagnosis. The perspective is to adapt therapeutic education to individual patient profile, with the objective to improve compliance.
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Affiliation(s)
- C Ostrowka
- Internal Medicine Department, Louis-Mourier Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Colombes, France
| | - L Journeau
- Internal Medicine Department, Louis-Mourier Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Colombes, France; Paris University, Paris, France
| | - L Plaisance
- Internal Medicine Department, Louis-Mourier Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Colombes, France; Paris University, Paris, France
| | - G Poenou
- Internal Medicine Department, Louis-Mourier Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Colombes, France; Paris University, Paris, France
| | - S E Mecherour
- Internal Medicine Department, Louis-Mourier Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Colombes, France
| | - H Helfer
- Internal Medicine Department, Louis-Mourier Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Colombes, France
| | - I Mahé
- Internal Medicine Department, Louis-Mourier Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Colombes, France; Paris University, Paris, France; Paris University, Innovative Therapies in Haemostasis, INSERM, 75006 Paris, France; F-CRIN INNOVTE, Saint-Étienne, France.
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Hecht JP, LaDuke ZJ, Cain-Nielsen AH, Hemmila MR, Wahl WL. Effect of Preinjury Oral Anticoagulants on Outcomes Following Traumatic Brain Injury from Falls in Older Adults. Pharmacotherapy 2020; 40:604-613. [PMID: 32515829 DOI: 10.1002/phar.2435] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Warfarin has been the oral anticoagulant of choice for the treatment of thromboembolic disease. However, upward of 50% of all new anticoagulant prescriptions are now for direct oral anticoagulants (DOAC). Despite this, outcome data evaluating preinjury anticoagulants remain scarce following traumatic brain injury (TBI). Our study objective is to determine the effects of preinjury anticoagulation on outcomes in older adults with TBI. METHODS Patient data were obtained from 29 level 1 and 2 trauma centers from 2012 to June 30, 2018. Overall, 8312 patients who were aged 65 years or older, suffering a ground level fall, and with an Abbreviated Injury Scale (AIS) head score of ≥ 3 were identified. Patients were excluded if they presented with no signs of life or a traumatic mechanism besides ground level fall. Statistical comparisons were made using multivariable analyses with anticoagulant/antiplatelet use as the independent variable. RESULTS Of the total patients with TBI, 3293 were on antiplatelet agents (AP), 669 on warfarin, 414 on warfarin + AP, 188 on DOACs, 116 on DOAC + AP, and 3632 on no anticoagulant. There were 185 (27.7%) patients on warfarin and 43 (22.9%) on a DOAC with a combined outcome of mortality or hospice as compared to 575 (15.8%) in the no anticoagulant group (p<0.001). After adjusting for patient factors, there was an increased risk of mortality or hospice in the warfarin (OR 1.60; 95% CI 1.27-2.01) and DOAC group (OR 1.67; 95% CI 1.07-2.59) as compared to no anticoagulant. Warfarin + AP was associated with an increased risk of mortality or hospice (OR 1.61; 95% CI 1.18-2.21) that was not seen with DOAC + AP (OR 0.93; 95% CI 0.46-1.87) as compared to no anticoagulant. CONCLUSIONS In older adults with TBI, preinjury treatment with warfarin or DOACs resulted in an increased risk of mortality or hospice whereas preinjury AP therapy did not increase risk. Future studies are needed with larger sample sizes to directly compare TBI outcomes associated with preinjury warfarin versus DOAC use.
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Affiliation(s)
- Jason P Hecht
- Inpatient Pharmacy, Saint Joseph Mercy, Ann Arbor, Michigan, USA
| | - Zachary J LaDuke
- Inpatient Pharmacy, Saint Joseph Mercy, Ann Arbor, Michigan, USA
| | | | - Mark R Hemmila
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Wendy L Wahl
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Barrios V, Escobar C, Gómez-Doblas JJ, Fernández-Dueñas J, Garrido RR, Rodríguez JP, Sánchez JU, Arellano-Rodrigo E, Donado E. Patients' perceptions with dabigatran in patients with atrial fibrillation previously treated with vitamin K antagonists. J Comp Eff Res 2020; 9:615-625. [PMID: 32469278 DOI: 10.2217/cer-2020-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To analyze the perception of anticoagulation with dabigatran in patients with nonvalvular atrial fibrillation previously treated with vitamin K antagonists over a 6-month period. Materials & methods: This is a prospective, noninterventional, noncontrolled, multicenter study. To assess patients' perceptions, PACT-Q2 questionnaire was completed. Results: Six hundred and fifty nine patients (73.1 ± 9.4 years, CHA2DS2-VASc 3.6 ± 1.6) were included. At baseline, the convenience and satisfaction scores were 60.9 ± 24.9 and 49.9 ± 17.7, respectively. The scores significantly increased along the study. Convenience score was higher in males and in patients with low-moderate thromboembolic risk. Satisfaction score was higher in females. Only 8.0% of patients discontinued dabigatran (3.7% due to side effects). Conclusion: Convenience and satisfaction scores for nonvalvular atrial fibrillation patients treated with dabigatran at 6 months were significantly better than with previous vitamin K antagonists.
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Affiliation(s)
- Vivencio Barrios
- Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Carlos Escobar
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Juan José Gómez-Doblas
- Cardiology Department, Hospital Clínico Universitario Virgen de la Victoria, CIBERCV, Málaga, Spain
| | | | | | | | | | | | - Esther Donado
- Medical Affairs Department, Boehringer-Ingelheim, Sant Cugat del Vallès, Barcelona, Spain
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Sridharan K, Al Banny R, Qader AM, Husain A, Qader KM. Health-related quality of life in patients receiving oral anti-coagulants: a cross-sectional study. Expert Rev Cardiovasc Ther 2020; 18:309-314. [DOI: 10.1080/14779072.2020.1760092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Kannan Sridharan
- Department of Pharmacology & Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Rashed Al Banny
- Department of Cardiology, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain
| | - Ali Mohamed Qader
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Aysha Husain
- Department of Cardiology, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain
- RCSI-Bahrain, Manama, Kingdom of Bahrain
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Quality of life after switching from well-controlled vitamin K antagonist to direct oral anticoagulant: Little to GAInN. Thromb Res 2020; 190:69-75. [PMID: 32315869 DOI: 10.1016/j.thromres.2020.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/04/2020] [Accepted: 04/06/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Direct oral anticoagulants (DOAC) and vitamin K antagonists (VKA) prevent thromboembolism in atrial fibrillation (AF). DOAC have a fixed dosing regimen and obviate INR monitoring. Therefore, DOAC presumably affect quality of life (QoL) less than VKA. However, some VKA users appreciate the monitoring. A high time in the therapeutic range (TTR) leads to a lower impact on QoL. We assessed the influence of switching from well-controlled VKA to a DOAC on QoL. METHODS In the GAInN study, 241 patients with AF, a TTR ≥ 70%, and neither bleeding nor thrombosis while on VKA were randomised to switching to DOAC (n = 121) or continuing VKA (n = 120). Health-related (SF-36) and anticoagulation-related QoL (PACT-Q) was assessed at baseline and after six and twelve months of follow-up. RESULTS AND CONCLUSION SF-36 development did not differ between groups. After one year, average PACT-Q Convenience improvement was 2.5 (0.3-4.7) higher on DOAC. DOAC users were 6percentage points (95%CI -4-16) more likely to improve >5 points on Convenience; 22 pp. (95%CI 1-43) in patients who scored <95/100 at baseline. The probability to meaningfully improve on PACT-Q Satisfaction was 12 pp. (95%CI 0-25) higher on DOAC. However, 5 (4.1%) and 4 (3.3%) DOAC users resumed VKA because of side-effects and patient preference. Switching from well-controlled VKA to DOAC for AF leads to a higher probability of improved PACT-Q convenience and satisfaction, but also to a higher risk of side-effects. Arguably only patients who are not satisfied with VKA should switch, because they have more to gain by switching.
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Althemery AU, Alfaifi AA, Alturaiki A, Ammari MAL, Sultana K, Lai L. A comparison between warfarin and apixaban: A patient's perspective. Ann Thorac Med 2020; 15:84-89. [PMID: 32489443 PMCID: PMC7259398 DOI: 10.4103/atm.atm_352_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/23/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Novel oral anticoagulants (NOACs) were developed as alternatives to warfarin. However, the patients' preference regarding warfarin or the NOACs has not been established. Quality-of-life (QOL) surveys are a well-established method for determining the patients' preference for a treatment route. AIMS This study compared the patients' perspectives on treatment with warfarin versus apixaban using the QOL measures. SETTINGS AND DESIGN This cross-sectional study was conducted in 2019 for patients treated with either warfarin or apixaban at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. METHODS We used a series of descriptive statistics to examine the differences in sociodemographic characteristics among patients. A propensity score-matching approach was employed to reduce the effect of confounding variables that often influence treatment selection. Greedy matching approach was used to analyze the QOL. RESULTS A total of 388 patients were identified, of which 124 were matched between the two groups (62 patients in each group). Most of the patients were female, married, below the sufficiency level, educated, and nonsmokers. The patients using warfarin had a significantly better health state (M = 69.64, standard deviation [SD] = 16.52) than those using apixaban (M = 66.33, SD = 23.17), P = 0.011. CONCLUSIONS Future studies should explore why patients using apixaban showed lower QOL scores and improve health-care providers' awareness of these issues.
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Affiliation(s)
- Abdullah U Althemery
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Abdullah A Alfaifi
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Abdulrahman Alturaiki
- Department of Pharmaceutical Care, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Maha A L Ammari
- Department of Pharmaceutical Care, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khizra Sultana
- Department of Pharmaceutical Care, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Leanne Lai
- Sociobehavioral Administrative Pharmacy, Nova Southeastern University, College of Pharmacy 3200 S. University Drive, Ft. Lauderdale, FL, USA
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Vinereanu D, Napalkov D, Bergler-Klein J, Benczur B, Ciernik M, Gotcheva N, Medvedchikov A, Põder P, Simic D, Skride A, Tang W, Trusz-Gluza M, Vesely J, Vishnepolsky T, Vrabec M. Patient perception of anticoagulant treatment for stroke prevention (RE-SONANCE study). Open Heart 2020; 7:e001202. [PMID: 32257246 PMCID: PMC7103803 DOI: 10.1136/openhrt-2019-001202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/20/2019] [Accepted: 02/10/2020] [Indexed: 11/04/2022] Open
Abstract
Objective We evaluated atrial fibrillation (AF) patients' perceptions of anticoagulation treatment with dabigatran or a vitamin K antagonist (VKA) for stroke prevention, according to accepted indications. Methods The RE-SONANCE observational, prospective, multicentre, international study used the validated Perception on Anticoagulant Treatment Questionnaire (PACT-Q) to assess patients with AF already taking a VKA who were switched to dabigatran (cohort A), and newly diagnosed patients initiated on either dabigatran or a VKA (cohort B). Visit 1 (V1) was at baseline, and visit 2 (V2) and visit 3 (V3) were at 30-45 and 150-210 days after baseline, respectively. Primary outcomes were treatment satisfaction and convenience in cohort A at V2 and V3 versus baseline, and in cohort B for dabigatran and a VKA at V2 and V3. Results The main analysis set comprised 4100 patients in cohort A and 5365 in cohort B (dabigatran: 3179; VKA: 2186). In cohort A, PACT-Q2 improved significantly (p<0.001 for all) for treatment convenience (mean change V1 vs V2=20.72; SD=21.50; V1 vs V3=24.54; SD=22.85) and treatment satisfaction (mean change V1 vs V2=17.60; SD=18.76; V1 vs V3=21.04; SD=20.24). In cohort B, mean PACT-Q2 scores at V2 and V3 were significantly higher (p<0.001 for all) for dabigatran versus a VKA for treatment convenience (V2=18.38; SE =0.51; V3=23.34; SE=0.51) and satisfaction (V2=15.88; SE=0.39; V3=19.01; SE=0.41). Conclusions Switching to dabigatran from long-term VKA therapy or newly initiated dabigatran is associated with improved patient treatment convenience and satisfaction compared with VKA therapy.
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Affiliation(s)
- Dragos Vinereanu
- Cardiology, University and Emergency Hospital of Bucharest, Bucharest, Other, Romania
| | - Dmitry Napalkov
- Department of Internal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Jutta Bergler-Klein
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Bela Benczur
- 1st Department of Internal Medicine (Cardiology/Nephrology), Tolna County 'Balassa Janos' Teaching Hospital, Szekszard, Hungary
| | | | - Nina Gotcheva
- Department of Cardiology, National Cardiology Hospital, Sofia, Bulgaria
| | | | - Pentti Põder
- Department of Cardiology, North Estonia Medical Centre Foundation, Tallinn, Estonia
| | - Dragan Simic
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Andris Skride
- Cardiology Department, Riga Stradins University, Riga, Latvia
| | - Wenbo Tang
- Biostatistics and Data Sciences, Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, Connecticut, USA
| | - Maria Trusz-Gluza
- First Department of Cardiology, Silesian Medical University, Katowice, Poland
| | - Jiri Vesely
- Faculty of Medicine in Hradec Kralové, Charles University, Broumov, Czech Republic
| | | | - Mirej Vrabec
- Department of Cardiology, General Hospital Celje, Celje, Slovenia
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Magon A, Arrigoni C, Moia M, Mancini M, Dellafiore F, Manara DF, Caruso R. Determinants of health-related quality of life: a cross-sectional investigation in physician-managed anticoagulated patients using vitamin K antagonists. Health Qual Life Outcomes 2020; 18:73. [PMID: 32178684 PMCID: PMC7077005 DOI: 10.1186/s12955-020-01326-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/11/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Literature has paid little attention in describing the specific contribution of each modifiable and non-modifiable characteristics on health-related quality of life (HRQoL) in physician-managed anticoagulated patients using vitamin K antagonists (VKAs). To describe how patients' treatment-specific knowledge, health literacy, treatment beliefs, clinical, and socio-demographic characteristics influence HRQoL in Italian physician-managed anticoagulated patients using VKAs. METHODS Cross-sectional multicentre study with a consecutive sampling strategy, enrolling 164 long-term anticoagulated patients. Clinical and socio-demographic characteristics were collected from electronic medical records. Valid and reliable questionnaires were used to collect patients' treatment-specific knowledge, health literacy, beliefs about VKAs, physical and health perceptions. RESULTS Obtaining and understanding health information (i.e., communicative health literacy) positively predicts both adequate mental (ORadjusted = 10.9; 95%CI = 1.99-19.10) and physical (ORadjusted = 11.54; 95%CI = 1.99-34.45) health perceptions. Conversely, the ability to perform proper health decision making (i.e., critical health literacy) was associated with lower rates of adequate mental health perception (ORadjusted = 0.13; 95%CI = 0.03-0.63). Further, age negatively predicted physical health perception (ORadjusted = 0.87; 95%CI = 0.81-0.93). CONCLUSIONS Health literacy plays an interesting role in predicting HRQoL. The relationship between critical health literacy and mental health perception could be influenced by some psychological variables, such as distress and frustration, which could be present in patients with higher levels of critical health literacy, as they could be more inclined for self-monitoring. For this reason, future research are needed to identify the most suitable patients' profile for each OAC-management model, by longitudinally describing the predictive performance of each modifiable and non-modifiable determinant of HRQoL.
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Affiliation(s)
- Arianna Magon
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1 - 00133, Rome, Italy.
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Marco Moia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Michela Mancini
- Nursing Office, ASST Melegnano e della Martesana, Melzo, Italy
| | - Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Duilio F Manara
- School of Nursing, Vita-Salute San Raffaele University, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Mull HJ, Shin MH, Engle RL, Linsky AM, Kalver E, Lamkin R, Sullivan JL. Veterans Perceptions of Satisfaction and Convenience with Anticoagulants for Atrial Fibrillation: Warfarin versus Direct Oral Anticoagulants. Patient Prefer Adherence 2020; 14:1911-1922. [PMID: 33116435 PMCID: PMC7569027 DOI: 10.2147/ppa.s279621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/29/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AFib) is associated with high morbidity and mortality. Traditionally, AFib was treated with warfarin, yet recent evidence suggests patients may favor direct oral anticoagulants (DOACs). Variation in preferences is common and we explored patients' perceptions of satisfaction and convenience of DOACs versus warfarin within the Veterans Health Administration (VA). PATIENTS AND METHODS We administered a cross-sectional survey, the Perception of Anticoagulant Treatment Questionnaire 2 (PACT-Q2), to Veterans residing in New England, age ≥65, diagnosed with AFib, and actively taking anticoagulant medication in fiscal year 2018. Survey recipients were randomly selected among patients on warfarin (n=200) or DOACs (n=200). A selection of survey respondents agreed to a follow-up semi-structured interview (n=16) to further investigate perceptions of satisfaction and convenience. RESULTS Of 400 patients, 187 completed the PACT-Q2 survey (49% on DOACs; 51% on warfarin). DOACs received significantly higher convenience ratings than warfarin (87.6, SD 13.5 vs 81.1, SD 18.8; p=0.007); there was no difference in satisfaction (64.2, SD 20.5 SD, warfarin vs, 67.3, SD 19.4, DOACs). Interview results showed that participants perceived their treatment to be convenient. However, participants expressed challenges related to the convenience of taking warfarin or DOACs, such as warfarin users having to follow dietary recommendations or DOAC users desiring some additional monitoring to answer questions or concerns. Overall, warfarin and DOAC users reported satisfaction with ongoing monitoring methods, although a few DOAC users expressed uncertainties with the frequency of monitoring. For most participants, concerns about side effects did not differ by anticoagulant type nor affect satisfaction. CONCLUSION Our survey and interview results showed variable patient satisfaction and perceptions of convenience with both DOACs and warfarin. Although DOACs are increasingly prescribed for AFib, some Veterans felt that regular follow-up on warfarin was advantageous. Our findings demonstrate the importance of patient-centered decision-making in AFib treatment in the VA patient population.
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Affiliation(s)
- Hillary J Mull
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USA
- Department of Surgery, Boston University School of Medicine, Boston, MA, USA
- Correspondence: Hillary J Mull VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USATel +1-857-364-2766 Email
| | - Marlena H Shin
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USA
| | - Ryann L Engle
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USA
| | - Amy M Linsky
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USA
- General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
- General Internal Medicine, VA Boston Healthcare System, Boston, MA, USA
| | - Emily Kalver
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USA
| | - Rebecca Lamkin
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USA
| | - Jennifer L Sullivan
- VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR), Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Barrios V, Escobar C, Barón Esquivias G, Gómez Doblas J, Recalde del Vigo E, Segura Martínez L, Alvarez Garcia P, Alonso Valladares F, Toril Lopez J, Chopo Alcubilla J. Quality of life, adherence and satisfaction of patients with auricular fibrillation treated with dabigatran or vitamin K antagonists. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2018.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Montero-Pérez-Barquero M, Manzano L. Quality of life, compliance and satisfaction of patients with atrial fibrillation who are undergoing anticoagulant treatment. Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation: Results from GARFIELD-AF. Am Heart J 2019; 213:35-46. [PMID: 31128503 DOI: 10.1016/j.ahj.2019.03.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/27/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION A principal aim of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) was to document changes in treatment practice for patients with newly diagnosed atrial fibrillation during an era when non-vitamin K antagonist oral anticoagulants (NOACs) were becoming more widely adopted. In these analyses, the key factors which determined the choice between NOACs and vitamin K antagonists (VKAs) are explored. METHODS Logistic least absolute shrinkage and selection operator regression determined predictors of NOAC and VKA use. Data were collected from 24,137 patients who were initiated on AC ± antiplatelet (AP) therapy (NOAC [51.4%] or VKA [48.6%]) between April 2013 and August 2016. RESULTS The most significant predictors of AC therapy were country, enrolment year, care setting at diagnosis, AF type, concomitant AP, and kidney disease. Patients enrolled in emergency care or in the outpatient setting were more likely to receive a NOAC than those enrolled in hospital (OR 1.16 [95% CI: 1.04-1.30], OR: 1.15 [95% CI: 1.05-1.25], respectively). NOAC prescribing seemed to be favored in lower-risk groups, namely, patients with paroxysmal AF, normotensive patients, and those with moderate alcohol consumption, but also the elderly and patients with acute coronary syndrome. By contrast, VKAs were preferentially used in patients with permanent AF, moderate to severe kidney disease, heart failure, vascular disease, and diabetes and with concomitant AP. CONCLUSION GARFIELD-AF data highlight marked heterogeneity in stroke prevention strategies globally. Physicians are adopting an individualized approach to stroke prevention where NOACs are favored in patients with a lower stroke risk but also in the elderly and patients with acute coronary syndrome.
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Afzal SK, Hasan SS, Babar ZUD. A systematic review of patient-reported outcomes associated with the use of direct-acting oral anticoagulants. Br J Clin Pharmacol 2019; 85:2652-2667. [PMID: 31077431 DOI: 10.1111/bcp.13985] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/02/2019] [Accepted: 04/24/2019] [Indexed: 12/26/2022] Open
Abstract
AIMS Patient-reported outcomes (PROs) are a distinctive method of evaluating patient response to health care or treatment. This systematic review aimed to analyse the impact of PROs in patients on direct oral anticoagulant (DOAC) treatment, prescribed for any indication (e.g. venous thromboembolism treatment or atrial fibrillation) using controlled trials (CT) and real-world observational studies (OS). METHODS A systematic search of articles was conducted according to PRISMA guidelines using databases, with the last update in November 2018. The Cochrane Collaboration tool for assessing bias in randomized CTs and the Newcastle-Ottawa Scale adapted for cross-sectional studies were used. Outcomes evaluated were related to health-related quality of life (HRQoL), satisfaction, adherence and compliance. RESULTS Twenty-one original studies (6 CT, 15 OS) were included. HRQoL was assessed by 6 (1 CT, 5 OS) studies and reported that HRQoL scores were similar in patients on DOACs and warfarin. Patients prescribed DOACs presented higher HRQoL scores which were attributed to lack of intense monitoring required compared with warfarin but this was not statistically significant. The majority of studies (5 CT, 9 OS) investigated patient-reported satisfaction, indicating greater satisfaction with DOACs with significantly lower burden and increased benefit scores for patients on DOACs. Patient-reported expectations, compliance and adherence were similar for patients on DOACs and warfarin. CONCLUSION Patients appear to prefer treatment with DOACs vs warfarin. This is shown by the higher quality of life, satisfaction and adherence described in the studies. However, heterogeneity in the analysed studies does not allow firm conclusions.
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Affiliation(s)
| | - Syed Shahzad Hasan
- University of Huddersfield, Queensgate, Huddersfield, West Yorkshire, UK
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Treatment Expectations, Convenience, and Satisfaction with Anticoagulant Treatment: Perceptions of Patients in South-East Queensland, Australia. J Clin Med 2019; 8:jcm8060863. [PMID: 31212944 PMCID: PMC6617501 DOI: 10.3390/jcm8060863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/03/2019] [Accepted: 06/14/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Warfarin has long been the only oral anticoagulant (OAC) available, but options now include non-vitamin K antagonists. Prescribing an OAC may be influenced by patient factors and preferences influenced by dosing, monitoring, and adverse effects, which may ultimately impact patient satisfaction and convenience. The aim of this study was to explore the perception of OAC treatment by Australian patients in terms of treatment expectations, convenience, and satisfaction. Methods: The Perception of Anticoagulant Treatment Questionnaire was distributed to patients dispensed OAC medication from three pharmacies in South-East Queensland. Responses to questions using a five-point Likert scale were collated and mean results utilised to assess expectations, convenience, and satisfaction, including an analysis across demographic groups. Results: A total of 56 (26.8%) surveys were returned, with the majority of respondent’s male (58.2%). Highest mean scores for treatment expectation were for an OAC that was easy to take (4.85 ± 0.79) and that could be taken care of by the respondents themselves (4.11 ± 1.14). The mean overall score for convenience was 68.90 ± 11.44% and for satisfaction 69.43 ± 16.58%. Significantly higher mean convenience scores were found in females and patients with atrial fibrillation. Conclusions: Patients’ highest expectations were for an OAC that would be easy to take, and overall satisfaction and convenience was around 69%. Factors including demographics can influence perceptions of therapy, and addressing individual preferences for OAC therapy may increase ratings of satisfaction and convenience.
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Differences between patient-driven adherence to vitamin K antagonists and direct oral anticoagulants. Do few missed doses matter? ACO-MEMS Study. Thromb Res 2019; 179:20-27. [PMID: 31075697 DOI: 10.1016/j.thromres.2019.04.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 04/05/2019] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Lack of INR controls might affect the adherence to direct oral anticoagulants (DOAC). The vast majority of studies that addresses adherence to anticoagulants are retrospective and based on pharmacy refill data. Our aim was to compare the adherence between vitamin K antagonists (VKA) and DOAC and to analyze the clinical relevance of non-adherence. MATERIALS AND METHODS A prospective two-arm observational cohort study was performed in two Spanish public hospitals. Adherence was assessed by Medication Event Monitoring System. Relationship between adherence and events during follow-up and time in therapeutic range (TTR) in the VKA group were analyzed. RESULTS 257 patients were included (132 DOAC and 125 VKA). Monitoring time was 120 days (101-133). Patients in VKA group showed higher taking adherence (97.9% vs. 95.8%) and less non-adherent patients of >5% and >10% of the doses, without differences in >20% of the doses. Taking adherence was strongly associated with TTR (AUC: 0.89, CI 95%: 0.81-0.97 of TTR for detection of non-adherent patients of >10% of doses). During a follow-up of 1.8 years (1.6-2) non-adherent patients of >5% of doses presented more thromboembolic events (HR 6.1, CI95% 1.3-28.1). CONCLUSIONS Although adherence to oral anticoagulant therapy was excellent, it was higher to VKA than to DOAC. Time in therapeutic range was highly sensitive to few missed doses of AVK. Non-adherence of >5% of prescribed doses had high clinical relevance.
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Direct Oral Anticoagulants Versus Vitamin K Antagonists in Patients Undergoing Cardioversion for Atrial Fibrillation: a Systematic Review and Meta-analysis. Cardiovasc Drugs Ther 2019; 33:339-352. [DOI: 10.1007/s10557-019-06869-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Quality of life, compliance and satisfaction of patients with atrial fibrillation who are undergoing anticoagulant treatment. Rev Clin Esp 2019; 219:320-321. [PMID: 30992140 DOI: 10.1016/j.rce.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 11/22/2022]
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Barrios V, Escobar C, Barón Esquivias G, Gómez Doblas JJ, Recalde Del Vigo E, Segura Martínez L, Alvarez Garcia P, Alonso Valladares F, Toril Lopez J, Chopo Alcubilla JM. Quality of life, adherence and satisfaction of patients with auricular fibrillation treated with dabigatran or vitamin K antagonists. Rev Clin Esp 2019; 219:285-292. [PMID: 30894251 DOI: 10.1016/j.rce.2018.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To analyse the quality of life, adherence and satisfaction of patients with nonvalvular auricular fibrillation (NVAF) treated with dabigatran versus vitamin K antagonists (VKA) in cardiology consultations in Spain. METHODS We conducted an observational, comparative, prospective and multicentre study of patients with NVAF treated in cardiology departments, who started treatment with dabigatran or VKA in the month prior to the baseline visit. The follow-up lasted 6 months. We analysed quality of life (using the validated AF-QoL 18 questionnaire [0, minimum; 100, maximum]), adherence (using the Morisky-Green test) and the cardiologist's perception (using a specific questionnaire [0, completely dissatisfied; 10, completely satisfied]). RESULTS We analysed 1015 patients (mean age, 73.3±9.4 years; 57% men; CHA2DS2VASc, 3.4±1.5; HAS-BLED, 1.5±1.0) who were treated with dabigatran (74.7%) or with VKA (25.3%). The total quality-of-life scores remained constant throughout the follow-up (47.9±23.5 and 48.6±24.4 at baseline and at 6 months, respectively; P=NS) but were higher at 6 months for the dabigatran group (50.6±24.7 vs. 42.8±22.5; P<.001). Treatment adherence was high during the study but greater with dabigatran at 6 months (89.2% vs. 81.1%; P=.001). There was a better perception of the cardiologist regarding the satisfaction of the patients treated with dabigatran at 6 months (9.0±1.2 vs. 6.6±2.2; P<.001). CONCLUSIONS For patients with NVAF and high thromboembolic risk treated in cardiology consultations, the adherence, satisfaction and quality of life were higher for the patients treated with dabigatran than for those treated with VKA.
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Affiliation(s)
- V Barrios
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - C Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
| | | | - J J Gómez Doblas
- Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, España
| | | | | | - P Alvarez Garcia
- Servicio de Cardiología, Fundación Hayge, Viladecans, Barcelona, España
| | | | - J Toril Lopez
- Servicio de Cardiología, Centre Medic Castelldefels, Castelldefels, Barcelona, España
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Ng DLC, Gan GG, Chai CS, Chee KH, Tan KL, Tan SB, Bee PC. Comparing quality of life and treatment satisfaction between patients on warfarin and direct oral anticoagulants: a cross-sectional study. Patient Prefer Adherence 2019; 13:1363-1373. [PMID: 31616136 PMCID: PMC6698611 DOI: 10.2147/ppa.s204246] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/27/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION AND AIM Patient quality of life (QOL) while on long-term oral anticoagulant therapy has been receiving greater attention in recent years due to the increase in life expectancy brought about by advances in medical care. This study aimed to compare the QOL, treatment satisfaction, hospitalization and bleeding rate in patients on long-term warfarin versus direct oral anticoagulants (DOAC). METHODS This was a cross-sectional study of patients with non-valvular atrial fibrillation (NVAF) or venous thromboembolism (VTE) on long-term anticoagulant therapy attending the cardiology clinic and anticoagulation clinic of the University Malaya Medical Centre from July 1, 2016, to June 30, 2018. Patient QOL was assessed by using the Short Form 12 Health Survey (SF12), while treatment satisfaction was assessed by using the Perception of Anticoagulation Treatment Questionnaire 2 (PACT-Q2). RESULTS A total of 208 patients were recruited; 52.4% received warfarin and 47.6% received DOAC. There was no significant difference in QOL between warfarin and DOAC based on SF12 (physical QOL, P=0.083; mental QOL, P=0.665). Nevertheless, patients in the DOAC group were significantly more satisfied with their treatment compared to the warfarin group based on PACT-Q2 (P=0.004). The hospitalisation rate was significantly higher in the warfarin group than the DOAC group (15.6% versus 3.0%, P=0.002). Clinically relevant minor bleeds and severe bleeding events were non-significantly higher in the warfarin group than the DOAC group (66.7% versus 40.0%, P=0.069). CONCLUSION Compared to warfarin, treatment of NVAF and VTE with DOAC showed comparable QOL, higher treatment satisfaction, lesser hospitalization, and a non-significant trend toward fewer bleeding episodes.
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Affiliation(s)
- Diana Leh-Ching Ng
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Gin-Gin Gan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Correspondence: Gin-Gin GanDepartment of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur50603, MalaysiaTel +60 37 949 2741Fax +60 37 955 6936Email
| | - Chee-Shee Chai
- Department of Medicine, Faculty of Medicine and Health Science, University Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Kok-Han Chee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kok-Leng Tan
- Department of Medicine, Faculty of Medicine, University Science Malaysia, Penang, Malaysia
| | - Seng-Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ping-Chong Bee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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