<p>Veterans Perceptions of Satisfaction and Convenience with Anticoagulants for Atrial Fibrillation: Warfarin versus Direct Oral Anticoagulants</p>

Abstract

Background: Atrial fibrillation (AFib) is associated with high morbidity and mortality. Traditionally, AFib was treated with warfarin, yet recent evidence suggests patients may favor direct oral anticoagulants (DOACs). Variation in preferences is common and we explored patients' perceptions of satisfaction and convenience of DOACs versus warfarin within the Veterans Health Administration (VA). Patients and Methods: We administered a cross-sectional survey, the Perception of Anticoagulant Treatment Questionnaire 2 (PACT-Q2), to Veterans residing in New England, age ≥65, diagnosed with AFib, and actively taking anticoagulant medication in fiscal year 2018. Survey recipients were randomly selected among patients on warfarin (n=200) or DOACs (n=200). A selection of survey respondents agreed to a follow-up semistructured interview (n=16) to further investigate perceptions of satisfaction and convenience. Results: Of 400 patients, 187 completed the PACT-Q2 survey (49% on DOACs; 51% on warfarin). DOACs received significantly higher convenience ratings than warfarin (87.6, SD 13.5 vs 81.1, SD 18.8; p=0.007); there was no difference in satisfaction (64.2, SD 20.5 SD, warfarin vs, 67.3, SD 19.4, DOACs). Interview results showed that participants perceived their treatment to be convenient. However, participants expressed challenges related to the convenience of taking warfarin or DOACs, such as warfarin users having to follow dietary recommendations or DOAC users desiring some additional monitoring to answer questions or concerns. Overall, warfarin and DOAC users reported satisfaction with ongoing monitoring methods, although a few DOAC users expressed uncertainties with the frequency of monitoring. For most participants, concerns about side effects did not differ by anticoagulant type nor affect satisfaction. Conclusion: Our survey and interview results showed variable patient satisfaction and perceptions of convenience with both DOACs and warfarin. Although DOACs are increasingly prescribed for AFib, some Veterans felt that regular follow-up on warfarin was advantageous. Our findings demonstrate the importance of patient-centered decisionmaking in AFib treatment in the VA patient population.

Reasons for nonadherence to the direct oral anticoagulant apixaban for atrial fibrillation

“…This concern likely extends to all anticoagulants and bleeding discussions should accompany all anticoagulant prescriptions. Consistent with studies demonstrating patient desire for DOAC monitoring, 9,10 some patients in this study wanted information on whether apixaban was working for them. DOAC concentration measurements with anti-Factor Xa activity assays are available, but monitoring is not routine.…”

The Influence of Frailty Syndrome and Dementia on the Convenience and Satisfaction with Oral Anticoagulation Treatment in Elderly Patients with Atrial Fibrillation

“…There are few studies assessing satisfaction of OAC treatment in the elderly in AF [3,4] or both satisfaction and convenience [15]. Convenience and satisfaction with OAC treatment is an important factor in assessing the effectiveness of treatment.…”

“…A similar mean score was shown for both convenience (82.9 ± 17.3) and satisfaction (63.4 ± 15.9 points [21]). Mull et al showed a mean score of 87.88 (SD = 16.69) for convenience and a mean score of 67.86 (SD = 19.96) for satisfaction with OAC treatment in elderly patients with AF [15]. Gospos and Bernaitis showed that the mean overall score in AF patients for convenience was 72.26 ± 10.71 and 67.97 ± 18.58 for satisfaction [22].…”