Patient satisfaction after switching from warfarin to apixaban in patients with nonvalvular atrial fibrillation: AGAIN study

Abstract

PurposePatients treated with warfarin must adhere to frequent monitoring, dietary restrictions, and complicated dose adjustments. Apixaban, a direct factor Xa inhibitor, is an alternative to warfarin that may reduce patient burdens associated with warfarin therapy. However, there is limited evidence pertaining to patient satisfaction with anticoagulant therapies in Japanese patients. The purpose of this observational study was to investigate changes in patient satisfaction after switching from warfarin to apixaban.Patients and methodsNonvalvular atrial fibrillation (NVAF) patients who were scheduled to switch anticoagulants from warfarin to apixaban were enrolled and treated with apixaban for 12 weeks. Patient satisfaction was assessed before the change in medication and after 12 weeks of treatment with apixaban using the Anti-Clot Treatment Scale (ACTS), a patient-reported instrument for measuring satisfaction with anticoagulation treatment. The ACTS includes a 12-item burden scale (maximum 60 points) and a 3-item benefit scale (maximum 15 points).ResultsAmong 732 NVAF patients enrolled, the full analysis set consisted of 697 patients who completed two ACTS assessments (one before the medication change and one 12 weeks after the change). Mean (±standard deviation) patient age was 76.2±9.1 years and mean CHADS2 score was 2.5±1.3. There were no significant changes in ACTS benefit scores. However, ACTS burden scores showed significant improvements at Week 12 compared to baseline (55.6±5.3 at Week 12 and 49.7±8.7 at baseline; P<0.0001). Factors associated with changes in ACTS burden scores from the multiple logistic regression analysis were age ≥70 years (odds ratio [OR]: 1.86; 95% confidence interval [CI]: 1.12–3.10; P=0.0169), baseline ACTS burden score (OR: 0.79; 95% CI: 0.75–0.82; P<0.0001), and use of non-steroidal anti-inflammatory drugs/antiplatelet drugs (OR: 0.60; 95% CI: 0.36–1.00; P=0.0499).ConclusionSwitching from warfarin to apixaban improved patient satisfaction with anticoagulant therapy in Japanese patients with NVAF by reducing burden of treatment.

A systematic review of patient‐reported outcomes associated with the use of direct‐acting oral anticoagulants

“…Of the 6 controlled trials, 5 were conducted in multiple countries (including UK, USA, Canada, Netherlands, France, Germany and Italy) [23][24][25]40,41 and 1 was conducted in Japan. 26 The observational studies (n = 15) used the following study designs: 11 prospective studies conducted in Spain, France, Canada, Japan, USA, Australia and Europe. Four of the studies were cross-sectional studies conducted in Spain, France and Canada (see Table 1).…”

“…In the case of controlled trials, 5 studies used randomized methods to generate the sequence, 23,24,26,40,41 and 1 study used some form of data checking for patient selection (see Table 2). 25 However, only 3 studies clearly described a form of concealed allocation and personnel and participant blinding.…”

Satisfaction of Patients with Nonvitamin K Anticoagulants Compared to Vitamin K Antagonists: a Systematic Review and Meta-analysis

“…The use of a therapy associated with higher satisfaction is a critical issue, due to its relationship to treatment adherence, 55,56 associated better anticoagulation control, 46 and consequently improved health outcomes. 49,57 Moreover, optimal adherence is essential to ensure both efficacy and safety with anticoagulant therapy and adherence to OACs remains a challenge in clinical practice.…”

“…Some did not demonstrate or report that dissatisfaction from previous NOAC or VKA treatment was not present at the start. 14,33,[44][45][46][47] Additionally, in some studies the outcome was assessed by nonblinded interviewers. 40,41,43,48,49 Moreover, in three studies there may be bias regarding the patients lost to follow-up.…”

A survey of reasons for continuing warfarin therapy in the era of direct oral anticoagulants in Japanese patients with atrial fibrillation: the SELECT study

“… 14 – 20 Although many patients with nonvalvular AF (NVAF) have switched to DOAC therapy, a significant proportion of patients are still treated with warfarin. The AGAIN study 38 was a prospective observational study conducted in Japanese patients with NVAF that investigated patient-reported satisfaction with apixaban after switching from warfarin (UMIN000018970). In this study, most physicians switched patients to apixaban in compliance with treatment guidelines, 21 but many patients remained on warfarin for reasons unsubstantiated by scientific evidence, including higher prices of DOACs compared to warfarin, lack of pressing reasons to switch (INR stably controlled within the therapeutic range), and fear of the potential risks of bleeding or ischemic events during the transition, either due to an overlap or a gap between warfarin and DOAC coverage.…”