scholarly journals Patient Perspectives on Factors Affecting Direct Oral Anticoagulant Use for Stroke Prevention in Atrial Fibrillation

2021 ◽  
Vol Volume 15 ◽  
pp. 953-966
Author(s):  
Kristina Medlinskiene ◽  
Susan Richardson ◽  
Beth Fylan ◽  
Katherine Stirling ◽  
Marcus Rattray ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Prevention ◽  
Oral Anticoagulant ◽  
Patient Perspectives ◽  
Direct Oral Anticoagulant ◽  
Factors Affecting

scholarly journals Patients’ perspectives on factors affecting their involvement in decision-making on oral anticoagulant therapy for stroke prevention in non-valvular atrial fibrillation

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i25-i26
Author(s):  
K Medlinskiene ◽  
S Richardson ◽  
D Petty ◽  
K Stirling ◽  
M Rattray ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Stroke Prevention ◽  
Oral Anticoagulant ◽  
Patient Involvement ◽  
Oral Anticoagulant Therapy ◽  
Pharmacy Practice ◽  
Medical Decision ◽  
Factors Affecting ◽  
Therapy Options

Abstract Introduction Acknowledging patients’ preferences and addressing their concerns is thought to improve patients’ satisfaction with consultations, resulting in improved adherence and health benefits [1]. Adherence to oral anticoagulant (OA) therapy in non-valvular atrial fibrillation (NVAF) is crucial to prevent AF-related strokes. Previous research on anticoagulation in NVAF indicated that decision-making was dominated by prescribers, but patients offered several therapy options reported being involved [2]. Identifying the patient’s perspective on factors affecting their involvement could help to deliver more patient-centred care in the management of AF. Aim To explore patients’ perspectives and experiences concerning factors affecting their involvement in decision-making about OA therapy for stroke prevention in NVAF. Methods Semi-structured face-to-face interviews were conducted with patients in three health economies in the North of England between August 2018 and April 2019. An interview topic guide based on narrative review findings [2] was developed and refined by a Patient and Public Involvement (PPI) group to ensure clarity. Theoretical sampling was used to recruit adults (>18 years) diagnosed with NVAF, prescribed OA (vitamin K antagonist or direct oral anticoagulant (DOAC)), and able to give written consent. Up to 30 potential participants were approached by a member of their direct care team (nurse or pharmacist) in secondary and primary care anticoagulation or arrhythmia clinics. PPI members recruited patients from a local patient support group. Data collection continued until data saturation was achieved. Audio recorded interviews were transcribed verbatim and analysed using the Framework method. Results A total of 21 patient with median (IQR) age of 73 years (65–78 years) were interviewed. Eleven patients took DOACs. The median (IQR) time of taking OA was 3 years (4 weeks-7 years), warfarin 7 years (3–9 years) and DOAC 1 year (4 weeks-4 years). Interviews lasted between 15 and 48 minutes (average 27 minutes). Three themes were identified during analysis (Figure 1). Patients described therapy decisions being made by just the clinician, jointly with the clinician, and in few cases by the patient alone. The lack of involvement resulted from patients perceiving that there was only a choice between accepting and refusing the therapy, and clinician’s role was to make decisions. Limited consultation times, lack of continuous relationship with a clinician and knowledge about OAs options discouraged patients from being involved and some patients reported difficulties with the prescribed therapy. Patients that were involved considered safety of therapy options and impact on daily life. Conclusions Limited consultation time, patient’s perception of clinician’s role, quality of patient-clinician relationship, and patients’ awareness of therapy options were main factors influencing the level of patient involvement in the decision-making. Support from both organisation and clinicians (e.g., longer consultations, availability of different therapy options) is needed to facilitate greater patient involvement, which could prevent difficulties encountered by some patients. The main strength of this study was recruitment of participants from three health economies differing in anticoagulation service provision models, which enabled greater insight into potential barriers. However, the sample was lacking ethnic diversity and could have potential of recall bias. References 1. Shay LA and Lafata JE. (2015). Where is the evidence? A systematic review of shared decision making and patient outcomes. Medical Decision Making. 35 (1): 114–131. 2. Medlinskiene K, Petty D, Richardson S and Stirling K. (2018) Are patients with non-valvular atrial fibrillation involved in decision-making about oral anticoagulants? A literature review. International Journal of Pharmacy Practice. 26 (Suppl. 1): 42–43.

scholarly journals Trends in initiation of direct oral anticoagulant therapies for atrial fibrillation in a national population-based cross-sectional study in the French health insurance databases

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e018180 ◽  
Author(s):  
Laetitia Huiart ◽  
Cyril Ferdynus ◽  
Christel Renoux ◽  
Amélie Beaugrand ◽  
Sophie Lafarge ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
National Health ◽  
Oral Anticoagulant ◽  
Vitamin K Antagonists ◽  
Population Based ◽  
Administrative Database ◽  
Direct Oral Anticoagulant ◽  
Health Authorities ◽  
First Choice

ObjectiveUnlike several other national health agencies, French health authorities recommended that the newer direct oral anticoagulant (DOAC) agents only be prescribed as second choice for the treatment of newly diagnosed non-valvular atrial fibrillation (NVAF), with vitamin K antagonists (VKA) remaining the first choice. We investigated the patterns of use of DOACs versus VKA in the treatment of NVAF in France over the first 5 years of DOAC availability. We also identified the changes in patient characteristics of those who initiated DOAC treatment over this time period.MethodsBased on the French National Health Administrative Database, we constituted a population-based cohort of all patients who were newly treated for NVAF between January 2011 and December 2015. Trends in drug use were described as the percentage of patients initiating each drug at the time of treatment initiation. A multivariate analysis using logistic regression model was performed to identify independent sociodemographic and clinical predictors of initial anticoagulant choice.ResultsThe cohort comprised 814 446 patients who had received a new anticoagulant treatment for NVAF. The proportion of patients using DOACs as initial anticoagulant therapy reached 54% 3 months after the Health Ministry approved the reimbursement of dabigatran for NVAF, and 61% by the end of 2015, versus VKA use. In the multivariate analysis, we found that DOAC initiators were younger and healthier overall than VKA initiators, and this tendency was reinforced over the 2011–2014 period. DOACs were more frequently prescribed by cardiologists in 2012 and after (adjusted OR in 2012: 2.47; 95% CI 2.40 to 2.54).ConclusionDespite recommendations from health authorities, DOACs have been rapidly and massively adopted as initial therapy for NVAF in France. Observational studies should account for the fact that patients selected to initiate DOAC treatment are healthier overall, as failure to do so may bias the risk–benefit assessment of DOACs.

scholarly journals Oral anticoagulant use for stroke prevention in atrial fibrillation patients with difficult scenarios

2018 ◽  
Vol 20 ◽  
pp. 56-62 ◽  
Author(s):  
Ting-Yung Chang ◽  
Jo-Nan Liao ◽  
Tze-Fan Chao ◽  
Jennifer Jeanne Vicera ◽  
Chin-Yu Lin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Stroke Prevention ◽  
Oral Anticoagulant
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