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Crivera C, Nelson WW, Schein JR, et al. Attitudes toward anticoagulant treatment among nonvalvular atrial fibrillation patients at high risk of stroke and low risk of bleed. Patient Prefer Adherence. 2016;10:795-805doi: 10.2147/PPA.S106215.
Crivera, C., Nelson, W. W., Schein, J. R., & Witt, E. A. (2016). Attitudes toward anticoagulant treatment among nonvalvular atrial fibrillation patients at high risk of stroke and low risk of bleed. Patient preference and adherence, 10795-805. https://doi.org/10.2147/PPA.S106215
Crivera, Concetta, et al. "Attitudes toward anticoagulant treatment among nonvalvular atrial fibrillation patients at high risk of stroke and low risk of bleed." Patient preference and adherence vol. 10 (2016): 795-805. doi: https://doi.org/10.2147/PPA.S106215
Crivera C, Nelson WW, Schein JR, Witt EA. Attitudes toward anticoagulant treatment among nonvalvular atrial fibrillation patients at high risk of stroke and low risk of bleed. Patient Prefer Adherence. 2016 May 17;10:795-805. doi: 10.2147/PPA.S106215. eCollection 2016. PMID: 27274206; PMCID: PMC4876102.
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Patient Prefer Adherence. 2016 May 17;10:795-805. doi: 10.2147/PPA.S106215. eCollection 2016.

Attitudes toward anticoagulant treatment among nonvalvular atrial fibrillation patients at high risk of stroke and low risk of bleed.

Patient preference and adherence

Concetta Crivera, Winnie W Nelson, Jeff R Schein, Edward A Witt

Affiliations

  1. Janssen Scientific Affairs, LLC, Raritan, USA.
  2. Kantar Health, Princeton, NJ, USA.

PMID: 27274206 PMCID: PMC4876102 DOI: 10.2147/PPA.S106215

Abstract

BACKGROUND: Atrial fibrillation (AF) is associated with an increased risk of stroke. Anticoagulant (AC) therapies are effective at treating AF, but carry with them an increased risk of bleed. Research suggests that a large proportion of AF patients who have high risk of stroke and low risk of bleeding are not currently receiving AC treatment. The goal of this study was to understand the reasons why these patients do not engage in this potentially life-saving treatment.

METHOD: Through a self-report online survey, using validated instruments, 1,184 US adults who self-reported a diagnosis of AF were screened for the risk of stroke and bleed. Of these patients, 230 (19.4%) were at high risk of stroke, low risk of bleed, and not currently using an AC treatment, and were asked follow-up questions to assess their reasons for nontreatment, attitudes toward treatment, and attitudes toward dosing regimens.

RESULTS: The most common reasons patients stopped AC treatment were concerns regarding bleeding (27.8%) and other medical concerns (26.6%), whereas the most common reason cited for not being prescribed an AC in the first place was the use of antiplatelet therapy as an alternative (57.1%). In both cases, potentially erroneous decisions regarding perceived stoke and/or bleeding risk were also a factor. Finally, the largest factors regarding attitudes toward treatment and dosing regimen were instructions from an authority figure (eg, physician, pharmacist) and ease of use, respectively.

CONCLUSION: Results suggest that many AF patients who are at high risk of stroke but at low risk of bleed may not be receiving AC due to potentially inaccurate beliefs about risk. This study also found that AF patients place trust in physicians above other factors such as cost when making treatment decisions. Increased education of patients by physicians on the risks and benefits may be a simple strategy to improve outcomes.

Keywords: anticoagulants; atrial fibrillation; bleeding risk; stroke risk; treatment

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