Comparative Outcomes Between Direct Oral Anticoagulants, Warfarin, and Antiplatelet Monotherapy Among Chinese Patients with Atrial Fibrillation: A Population-Based Cohort Study

et al. 2020

BMC Health Serv Res

Self Cite

Background Despite international treatment guidelines currently advocating oral anticoagulants (OACs) as the only appropriate stroke prevention therapy for patients with atrial fibrillation (AF) and evidence that OACs can greatly reduce the risk of stroke with similar risk of bleeding compared with aspirin, the underuse of OACs in patients with AF is common globally, especially in Asia. This study aimed to identify the barriers to prescribing and using OACs among long-term aspirin users with AF. Method Face-to-face interviews were conducted with fourteen eligible patients with AF using a semi-structured interview guide. The interview recordings were transcribed verbatim and data was analyzed according to the principles of thematic analysis. Results Five themes were developed: awareness of AF symptoms and diagnosis; knowledge and understanding of AF and stroke prevention therapy; role of decision-making in prescribing; willingness to switch from aspirin to OACs; and impact of OAC regimen on daily living. The majority of the patients were not aware of the symptoms and diagnosis of AF and only had a vague understanding of the illness and stroke prevention therapy, leading to their minimal involvement in decisions relating to their treatment. Some patients and their caregivers were particularly concerned about the bleeding complications from OACs and perceived aspirin to be a suitable alternative as they find the adverse effects from aspirin manageable and so preferred to remain on aspirin if switching to OACs was not compulsory. Lastly, the lifestyle modifications required when using warfarin, e.g. alternative dosing regimen, diet restriction, were seen as barriers to some patients and caregivers. Conclusion The findings revealed patients’ knowledge gap in AF management which may be targeted using educational interventions to improve patients’ understanding of AF and its management and hence encourage active participation in the decision-making of their treatment in the future.

Section: Introductionmentioning

confidence: 68%

Understanding the barriers to using oral anticoagulants among long-term aspirin users with atrial fibrillation – a qualitative study

et al. 2020

BMC Health Serv Res

Self Cite

“…Similar ndings were observed in a recent study in Hong Kong. OACs were associated with lower risk of ischemic stroke and all-cause mortality compared to antiplatelets but both OACs and antiplatelets demonstrated a comparable risk of gastrointestinal bleeding (16). These ndings support the fact that antiplatelet drugs should not be recommended as rst-line therapy for stroke prevention in high-risk AF patients (8,(15)(16)(17).…”

Section: Introductionmentioning

confidence: 57%

“…Firstly, the sample size was limited. Although the participants were recruited from two local hospitals only, the mean age of rst diagnosis of AF is 81.9 years in our study, which is similar to 80.0 years in the AF cohort in previous study using the electronic healthcare database covering patients who have utilized services in public hospitals in Hong Kong (16). The two local hospitals where patients were recruited from are publicly funded by the Hong Kong Hospital Authority and participants in our cohort can also be found in the same database.…”

Section: Limitationsmentioning

confidence: 68%

“…In the UK, the use of OACs in patients with AF increased from 54.7% in 2011 to 73.9% in 2016 while the use of antiplatelet drugs declined from 36.4% to 10.5% over the same period (20). In Hong Kong, the proportion of AF patients receiving antiplatelet therapy was almost twice as those receiving OACs (43% vs 26%) in 2016 (16). Similarly, the overall rate of antithrombotic therapy was 37.7%, with the use of aspirin and warfarin being 32.3% and 4.1% respectively in China (21).…”

Section: Introductionmentioning

confidence: 99%

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Understanding the barriers to using oral anticoagulants among long-term aspirin users with atrial fibrillation – A qualitative study

et al. 2020

Preprint

Background: Despite international treatment guidelines currently advocating oral anticoagulants (OACs) as the only appropriate stroke prevention therapy for patients with atrial fibrillation (AF) and evidence that OACs can greatly reduce the risk of stroke with similar risk of bleeding compared with aspirin, the underuse of OACs in patients with AF is common globally, especially in Asia. This study aimed to identify the barriers to prescribing and using OACs among long-term aspirin users with AF.Method: Face-to-face interviews were conducted with fourteen eligible patients with AF using a semi-structured interview guide. The interview recordings were transcribed verbatim and data was analyzed according to the principles of thematic analysis.Results: Five themes were developed: awareness of AF symptoms and diagnosis; knowledge and understanding of AF and stroke prevention therapy; role of decision-making in prescribing; willingness to switch from aspirin to OACs; and impact of OAC regimen on daily living. The majority of the patients were not aware of the symptoms and diagnosis of AF and only had a vague understanding of the illness and stroke prevention therapy, leading to their minimal involvement in decisions relating to their treatment. Some patients and their caregivers were particularly concerned about the bleeding complications from OACs and perceived aspirin to be a suitable alternative as they find the adverse effects from aspirin manageable and so preferred to remain on aspirin if switching to OACs was not compulsory. Lastly, the lifestyle modifications required when using warfarin, e.g. alternative dosing regimen, diet restriction, were seen as barriers to some patients and caregivers.Conclusion: The findings revealed patients’ knowledge gap in AF management which may be targeted using educational interventions to improve patients’ understanding of AF and its management and hence encourage active participation in the decision-making of their treatment in the future.

“…In the UK, the use of OACs in patients with AF increased from 54.7% in 2011 to 73.9% in 2016 while the use of antiplatelet drugs declined from 36.4-10.5% over the same period (20). In Hong Kong, the proportion of AF patients receiving antiplatelet therapy was almost twice as those receiving OACs (43% vs 26%) in 2006 (16).…”

Section: Introductionmentioning

confidence: 99%

Understanding the Barriers to Using Oral Anticoagulants Among Long-Term Aspirin Users With Atrial Fibrillation – A Qualitative Study

et al. 2020

Preprint

Background: Despite international treatment guidelines currently advocating oral anticoagulants (OACs) as the only appropriate stroke prevention therapy for patients with atrial fibrillation (AF) and evidence that OACs can greatly reduce the risk of stroke with similar risk of bleeding compared with aspirin, the underuse of OACs in patients with AF is common globally, especially in Asia. This study aimed to identify the barriers to prescribing and using OACs among long-term aspirin users with AF.Method: Face-to-face interviews were conducted with fourteen eligible patients with AF using a semi-structured interview guide. The interview recordings were transcribed verbatim and data was analyzed according to the principles of thematic analysis.Results: Five themes were developed: awareness of AF symptoms and diagnosis; knowledge and understanding of AF and stroke prevention therapy; role of decision-making in prescribing; willingness to switch from aspirin to OACs; and impact of OAC regimen on daily living. The majority of the patients were not aware of the symptoms and diagnosis of AF and only had a vague understanding of the illness and stroke prevention therapy, leading to their minimal involvement in decisions relating to their treatment. Some patients and their caregivers were particularly concerned about the bleeding complications from OACs and perceived aspirin to be a suitable alternative as they find the adverse effects from aspirin manageable and so preferred to remain on aspirin if switching to OACs was not compulsory. Lastly, the lifestyle modifications required when using warfarin, e.g. alternative dosing regimen, diet restriction, were seen as barriers to some patients and caregivers. Conclusion: The findings revealed patients’ knowledge gap in AF management which may be targeted using educational interventions to improve patients’ understanding of AF and its management and hence encourage active participation in the decision-making of their treatment in the future.