Educational Intervention Improves Anticoagulation Control in Atrial Fibrillation Patients: The TREAT Randomised Trial

Abstract

BackgroundStroke prevention in atrial fibrillation (AF), most commonly with warfarin, requires maintenance of a narrow therapeutic target (INR 2.0 to 3.0) and is often poorly controlled in practice. Poor patient-understanding surrounding AF and its treatment may contribute to the patient’s willingness to adhere to recommendations.MethodA theory-driven intervention, developed using patient interviews and focus groups, consisting of a one-off group session (1–6 patients) utilising an “expert-patient” focussed DVD, educational booklet, self-monitoring diary and worksheet, was compared in a randomised controlled trial (ISRCTN93952605) against usual care, with patient postal follow-ups at 1, 2, 6, and 12-months. Ninety-seven warfarin-naïve AF patients were randomised to intervention (n=46, mean age (SD) 72.0 (8.2), 67.4% men), or usual care (n=51, mean age (SD) 73.7 (8.1), 62.7% men), stratified by age, sex, and recruitment centre. Primary endpoint was time within therapeutic range (TTR); secondary endpoints included knowledge, quality of life, anxiety/depression, beliefs about medication, and illness perceptions.Main FindingsIntervention patients had significantly higher TTR than usual care at 6-months (76.2% vs. 71.3%; p=0.035); at 12-months these differences were not significant (76.0% vs. 70.0%; p=0.44). Knowledge increased significantly across time (F (3, 47) = 6.4; p<0.01), but there were no differences between groups (F (1, 47) = 3.3; p = 0.07). At 6-months, knowledge scores predicted TTR (r=0.245; p=0.04). Patients’ scores on subscales representing their perception of the general harm and overuse of medication, as well as the perceived necessity of their AF specific medications predicted TTR at 6- and 12-months.ConclusionsA theory-driven educational intervention significantly improves TTR in AF patients initiating warfarin during the first 6-months. Adverse clinical outcomes may potentially be reduced by improving patients’ understanding of the necessity of warfarin and reducing their perception of treatment harm. Improving education provision for AF patients is essential to ensure efficacious and safe treatment.The trial is registered with Current Controlled Trials, ISRCTN93952605, and details are available at www.controlled-trials.com/ISRCTN93952605.

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

“…The TREAT study found that baseline specific necessity beliefs were predictive of INR control at 1 year. Furthermore, they established links between baseline negative beliefs about medication and TTR 43. This finding is supported by our analysis where TTR >75% patients have higher necessity beliefs.…”

Can Phone-Based Motivational Interviewing Improve Medication Adherence to Antiplatelet Medications After a Coronary Stent Among Racial Minorities? A Randomized Trial

“…Unfortunately, other studies have also shown that simple educational interventions may not be sufficient to modify adherence behavior. [49][50][51] Lastly, we examined adherence to antiplatelet therapy at 12 months, since that is standard recommendation after a DES. However, expert opinion and guidelines, as well as the appropriate length of use of such medications continue to evolve.…”

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

“…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.…”