Educational and behavioural interventions for anticoagulant therapy in patients with atrial fibrillation

Clarkesmith, Danielle; Pattison, Helen; Khaing, Phyo; Lane, Deirdre A.

doi:10.1002/14651858.cd008600.pub3

Cited by 94 publications

(112 citation statements)

References 165 publications

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“…This review examined the effectiveness and characteristics of studies designed to increase appropriate OAC prescription in eligible AF patients for stroke prevention. Despite published reviews focusing on improving patient uptake of OACs, 42,43 this review represents the first rigorously conducted systematic evaluation of interventions to improve HCPs' prescribing behaviours in this field. Research published to date represents a wide variety of study designs, settings, interventions and theoretical approaches.…”

Section: Discussionmentioning

confidence: 99%

Improving the Prescription of Oral Anticoagulants in Atrial Fibrillation: A Systematic Review

et al. 2019

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Objective Oral anticoagulant (OAC) prescription for stroke prevention in atrial fibrillation (AF) patients frequently does not follow current guidelines, with underuse in patients at high risk of stroke and substantial overuse in those at low risk. This review aims to systematically evaluate the effectiveness of interventions to improve appropriate OAC prescription in eligible AF patients for stroke prevention. Methods Systematic review of controlled and uncontrolled studies published up to July 2017 with interventions designed to improve appropriate OAC prescription for stroke prevention in eligible AF patients (according to risk assessment tool or guidelines). Categorization of intervention types was pre-specified. The main outcome was change in proportion of eligible AF patients prescribed OACs for stroke prevention. Results Twenty studies conducted in 392 settings were included (cluster randomized controlled trials, controlled trials and uncontrolled before-after designs; n = 29,868 patients at baseline). Fifteen studies reported significant improvements in appropriate prescription of OACs in AF patients. All interventions with a persuasive element (8/8); all studies targeting health care professional (HCP) education or guideline/protocol implementation (7/7); and all medical care programs (4/4) achieved significant increases in appropriate OAC prescription. Computerized decision support interventions (3/5) and reviews of prescribing (2/4) were less likely to report significant improvements in appropriate OAC prescription. Conclusion Interventions designed to improve appropriate prescription of OACs in eligible AF patients for stroke prevention can be effective. Successful approaches include education of HCPs; implementation of local guidelines; interdisciplinary medical care programs educating both HCPs and patients and persuasive interventions utilizing peer-group experts. Protocol registration: PROSPERO (CRD42016039654).

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Section: Discussionmentioning

confidence: 99%

Improving the Prescription of Oral Anticoagulants in Atrial Fibrillation: A Systematic Review

et al. 2019

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“…In practice, clinicians should elicit these beliefs at the outset to ensure appropriate understanding. Although interventions in anticoagulation that have targeted education alone have had limited success,38, 39 there is scope to improve TTR by addressing inaccurate beliefs if combined with other behavior change techniques. Interventions utilising nonmedical personnel such as pharmacists and nurses have proved to be successful 40…”

Section: Discussionmentioning

confidence: 99%

“…37 In practice, clinicians should elicit these beliefs at the outset to ensure appropriate understanding. Although interventions in anticoagulation that have targeted education alone have had limited success, 38,39…”

Section: Understanding and Knowledge Of Illnessmentioning

confidence: 99%

Associations between illness beliefs, medication beliefs, anticoagulation‐related quality of life, and INR control: Insights from the Switching Study

Bartoli-Abdou

Patel

Xie

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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BackgroundAnticoagulation control with vitamin‐K antagonists (VKAs) in patients with atrial fibrillation (AF) or venous thromboembolism (VTE) can be measured using time in therapeutic range (TTR), where TTR >65% is considered good and low TTR may be associated with low adherence.MethodsThis cross‐sectional observational study compared illness beliefs, treatment beliefs, and treatment satisfaction of patients with TTR >75% and TTR <50% using validated tools to determine their association with TTR. Adults requiring chronic VKA therapy were recruited from 2 hospital anticoagulation clinics in London, UK.Results311 patients with TTR >75% and 214 with TTR <50% were recruited. TTR >75% patients had been taking warfarin on average over 2 years longer than TTR <50% patients (P < .001). Statistically significant differences in beliefs were found in all subscales other than in treatment control, general harm, and general overuse. Cluster analysis determined there were 4 distinct clusters of beliefs among patients. Multivariate binary logistic regression found VTE patients were least likely to have poor TTR (OR = 0.49; 95% CI 0.29, 0.77). Patients in the “cautious of therapy and fearful of illness” cluster were most likely to have low TTR (OR = 4.75; 95% CI 2.75, 8.77).ConclusionIllness perceptions, medication beliefs and treatment satisfaction were associated with INR control. VTE patients and those who were accepting of both illness and treatment were most likely to have optimal INR control.

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“…Pacjenci często nie mają jednak odpowiedniej wiedzy na temat AF -nawet ci, którzy otrzymali ustne i pi- semne informacje [32,1011,1012], co wskazuje na potrzebę dalszego rozwoju usystematyzowanej edukacji pacjentów. Opracowano kilka narzędzi do informowania pacjentów, koncentrujących się głównie na OAC [1013][1014][1015][1016]. Grupa robocza autorów niniejszych wytycznych opracowała specjalną aplikację dla pacjentów z AF w celu wsparcia ich informowania i edukowania.…”

Section: Zintegrowana Edukacja Pacjentówunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,339

4,206

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Educational and behavioural interventions for anticoagulant therapy in patients with atrial fibrillation

Cited by 94 publications

References 165 publications

Improving the Prescription of Oral Anticoagulants in Atrial Fibrillation: A Systematic Review

Improving the Prescription of Oral Anticoagulants in Atrial Fibrillation: A Systematic Review

Associations between illness beliefs, medication beliefs, anticoagulation‐related quality of life, and INR control: Insights from the Switching Study

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

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