Patients' Perceptions of Atrial Fibrillation, Stroke Risk, and Oral Anticoagulation Treatment: An International Survey

Deirdre A. Lane; Juliane Meyerhoff; Ute Rohner; Gregory Y. H. Lip

doi:10.1055/s-0038-1666803

TH Open, Table of Contents

CC BY 4.0 · TH Open 2018; 02(03): e233-e241
DOI: 10.1055/s-0038-1666803

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Patients' Perceptions of Atrial Fibrillation, Stroke Risk, and Oral Anticoagulation Treatment: An International Survey

Deirdre A. Lane

¹University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom

²Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

,

Juliane Meyerhoff

³Boehringer Ingelheim Pharma International GmbH, Ingelheim am Rhein, Germany

,

Ute Rohner

³Boehringer Ingelheim Pharma International GmbH, Ingelheim am Rhein, Germany

,

Gregory Y. H. Lip

¹University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom

²Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

› Author Affiliations

Abstract

Background Global differences exist in the management of atrial fibrillation (AF), and cultural differences may influence patients' expectations and perceptions of healthcare. This survey investigated whether country-specific differences in patients' perceptions of AF and oral anticoagulation (OAC) exist and if recent stroke influences these perceptions.

Methods Cross-sectional survey of 937 adults with nonvalvular AF receiving OAC for stroke prevention was conducted across United States, Canada, Germany, France, and Japan. Thirty-minute online interviews conducted between April and November 2015 included AF patients with recent stroke, and newly diagnosed AF and established AF, both without recent stroke.

Results U.S. patients and those with recent stroke perceived AF as more serious (54.0 and 55.2%, respectively) and were more concerned about stroke (50.0 and 68.0%, respectively). Japanese patients were more likely to perceive AF as not serious (41.0%), but 50.4% were frequently concerned about stroke. Patients in the United States, Canada, and Germany and those without recent stroke preferred to be involved in OAC treatment decisions (either shared decision making or patient's choice), while French and Japanese patients and those with recent stroke preferred their doctor to choose. For all country groups, stroke prevention was the most important factor when choosing OAC.

Conclusion In this international cohort of AF patients, country-specific differences exist in patients' perceptions of AF, concerns about stroke, and preference for involvement in OAC treatment decisions; recent experience of stroke significantly influenced patients' values and preferences regarding AF and treatment. Stroke prevention was rated as the most important factor when choosing OAC treatment.

Keywords

atrial fibrillation - oral anticoagulation - patients' perceptions - patient survey - stroke knowledge

Full Text

References

References
1 Kirchhof P, Benussi S, Kotecha D. , et al; ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37 (38) 2893-2962
2 Macle L, Cairns J, Leblanc K. , et al; CCS Atrial Fibrillation Guidelines Committee. 2016 focused update of the Canadian Cardiovascular Society guidelines for the management of atrial fibrillation. Can J Cardiol 2016; 32 (10) 1170-1185
3 National Institute for Health and Clinical Excellence (NICE). Atrial Fibrillation: The Management of Atrial Fibrillation. London: National Institute for Health and Care Excellence (UK); 2014
4 You JJ, Singer DE, Howard PA. , et al. Antithrombotic therapy for atrial fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2, Suppl): e531S-e575S
5 Alonso-Coello P, Montori VM, Díaz MG. , et al. Values and preferences for oral antithrombotic therapy in patients with atrial fibrillation: physician and patient perspectives. Health Expect 2015; 18 (06) 2318-2327
6 Andrade JG, Krahn AD, Skanes AC, Purdham D, Ciaccia A, Connors S. Values and preferences of physicians and patients with non-valvular atrial fibrillation who receive oral anticoagulation therapy for stroke prevention. Can J Cardiol 2016; 32 (06) 747-753
7 Lahaye S, Regpala S, Lacombe S. , et al. Evaluation of patients' attitudes towards stroke prevention and bleeding risk in atrial fibrillation. Thromb Haemost 2014; 111 (03) 465-473
8 Lane DA, Aguinaga L, Blomström-Lundqvist C. , et al. Cardiac tachyarrhythmias and patient values and preferences for their management: the European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace 2015; 17 (12) 1747-1769
9 Lane DA, Barker RV, Lip GY. Best practice for atrial fibrillation patient education. Curr Pharm Des 2015; 21 (05) 533-543
10 Lane DA, Lip GY. Patient's values and preferences for stroke prevention in atrial fibrillation: balancing stroke and bleeding risk with oral anticoagulation. Thromb Haemost 2014; 111 (03) 381-383
11 MacLean S, Mulla S, Akl EA. , et al. Patient values and preferences in decision making for antithrombotic therapy: a systematic review: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2, Suppl): e1S-e23S
12 Frankel DS, Parker SE, Rosenfeld LE, Gorelick PB. HRS/NSA 2014 survey of atrial fibrillation and stroke: gaps in knowledge and perspective, opportunities for improvement. J Stroke Cerebrovasc Dis 2015; 24 (08) 1691-1700
13 Moia M, Mantovani LG, Carpenedo M. , et al. Patient preferences and willingness to pay for different options of anticoagulant therapy. Intern Emerg Med 2013; 8 (03) 237-243
14 Aliot E, Breithardt G, Brugada J. , et al; Atrial Fibrillation AWareness And Risk Education group; Atrial Fibrillation Association; European Heart Rhythm Association; Stroke Alliance for Europe; World Heart Federation. An international survey of physician and patient understanding, perception, and attitudes to atrial fibrillation and its contribution to cardiovascular disease morbidity and mortality. Europace 2010; 12 (05) 626-633
15 Lane DA, Ponsford J, Shelley A, Sirpal A, Lip GY. Patient knowledge and perceptions of atrial fibrillation and anticoagulant therapy: effects of an educational intervention programme. The West Birmingham Atrial Fibrillation Project. Int J Cardiol 2006; 110 (03) 354-358
16 Lip GY, Agnelli G, Thach AA, Knight E, Rost D, Tangelder MJ. Oral anticoagulation in atrial fibrillation: a pan-European patient survey. Eur J Intern Med 2007; 18 (03) 202-208
17 McCabe PJ. What patients want and need to know about atrial fibrillation. J Multidiscip Healthc 2011; 4: 413-419
18 Amara W, Larsen TB, Sciaraffia E. , et al. Patients' attitude and knowledge about oral anticoagulation therapy: results of a self-assessment survey in patients with atrial fibrillation conducted by the European Heart Rhythm Association. Europace 2016; 18 (01) 151-155
19 McCabe PJ, Schumacher K, Barnason SA. Living with atrial fibrillation: a qualitative study. J Cardiovasc Nurs 2011; 26 (04) 336-344
20 Borg Xuereb C, Shaw RL, Lane DA. Patients' and physicians' experiences of atrial fibrillation consultations and anticoagulation decision-making: a multi-perspective IPA design. Psychol Health 2016; 31 (04) 436-455
21 Devereaux PJ, Anderson DR, Gardner MJ. , et al. Differences between perspectives of physicians and patients on anticoagulation in patients with atrial fibrillation: observational study. BMJ 2001; 323 (7323): 1218-1222
22 Böttger B, Thate-Waschke IM, Bauersachs R, Kohlmann T, Wilke T. Preferences for anticoagulation therapy in atrial fibrillation: the patients' view. J Thromb Thrombolysis 2015; 40 (04) 406-415
23 Ghijben P, Lancsar E, Zavarsek S. Preferences for oral anticoagulants in atrial fibrillation: a best-best discrete choice experiment. Pharmacoeconomics 2014; 32 (11) 1115-1127
24 Palacio AM, Kirolos I, Tamariz L. Patient values and preferences when choosing anticoagulants. Patient Prefer Adherence 2015; 9: 133-138
25 Farrell B, Godwin J, Richards S, Warlow C. The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results. J Neurol Neurosurg Psychiatry 1991; 54 (12) 1044-1054
26 Hernández Madrid A, Potpara TS, Dagres N. , et al. Differences in attitude, education, and knowledge about oral anticoagulation therapy among patients with atrial fibrillation in Europe: result of a self-assessment patient survey conducted by the European Heart Rhythm Association. Europace 2016; 18 (03) 463-467
27 Potpara TS, Pison L, Larsen TB, Estner H, Madrid A, Blomström-Lundqvist C. ; Scientific Initiatives Committee, and European Heart Rhythm Association. How are patients with atrial fibrillation approached and informed about their risk profile and available therapies in Europe? Results of the European Heart Rhythm Association Survey. Europace 2015; 17 (03) 468-472
28 Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med 1997; 44 (05) 681-692
29 Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med 1999; 49 (05) 651-661
30 Hess EP, Coylewright M, Frosch DL, Shah ND. Implementation of shared decision making in cardiovascular care: past, present, and future. Circ Cardiovasc Qual Outcomes 2014; 7 (05) 797-803
31 Laidsaar-Powell RC, Butow PN, Bu S. , et al. Physician-patient-companion communication and decision-making: a systematic review of triadic medical consultations. Patient Educ Couns 2013; 91 (01) 3-13
32 Seaburg L, Hess EP, Coylewright M, Ting HH, McLeod CJ, Montori VM. Shared decision making in atrial fibrillation: where we are and where we should be going. Circulation 2014; 129 (06) 704-710
33 Kneeland PP, Fang MC. Current issues in patient adherence and persistence: focus on anticoagulants for the treatment and prevention of thromboembolism. Patient Prefer Adherence 2010; 4: 51-60
34 Potpara TS, Lane DA, Lip GY. Optimizing stroke prevention in atrial fibrillation: better adherence and compliance from patients and physicians leads to better outcomes. Europace 2015; 17 (04) 507-508
35 Rodriguez RA, Carrier M, Wells PS. Non-adherence to new oral anticoagulants: a reason for concern during long-term anticoagulation?. J Thromb Haemost 2013; 11 (02) 390-394
36 Assessment of an education and guidance program for Eliquis adherence in non-valvular atrial fibrillation (AEGEAN) study. Available at: www.clinicaltrials.gov ; NCT01884350. Accessed June 6, 2018
37 Gorst-Rasmussen A, Skjøth F, Larsen TB, Rasmussen LH, Lip GY, Lane DA. Dabigatran adherence in atrial fibrillation patients during the first year after diagnosis: a nationwide cohort study. J Thromb Haemost 2015; 13 (04) 495-504
38 Shore S, Carey EP, Turakhia MP. , et al. Adherence to dabigatran therapy and longitudinal patient outcomes: insights from the Veterans Health Administration. Am Heart J 2014; 167 (06) 810-817
39 Tsai K, Erickson SC, Yang J, Harada AS, Solow BK, Lew HC. Adherence, persistence, and switching patterns of dabigatran etexilate. Am J Manag Care 2013; 19 (09) e325-e332
40 Protheroe J, Fahey T, Montgomery AA, Peters TJ. The impact of patients' preferences on the treatment of atrial fibrillation: observational study of patient based decision analysis. BMJ 2000; 320 (7246): 1380-1384