Patients’ and physicians’ perceptions and attitudes about oral anticoagulation and atrial fibrillation: a qualitative systematic review

Abstract

BackgroundOral anticoagulant therapy reduces the risk of stroke in patients with atrial fibrillation, but many patients are still not prescribed this therapy. The causes of underuse of vitamin K antagonists oral anticoagulants are not clear but could be related, in part, to patients’ and physicians’ perceptions and attitudes towards the benefits and downsides of this treatment. The purpose of this systematic review was to evaluate and synthesize patients’ and physicians’ perceptions and attitudes towards the benefits and downsides of vitamin K antagonist, in order to explore potential factors related with its underuse.MethodsWe included studies that used qualitative or mixed methods and focused on patients’ and/or physicians’ perceptions and attitudes towards oral anticoagulation. We systematically searched PubMed, EMBASE, ISI WoK, and PsycINFO from their inception until May 2013. Two reviewers independently assessed the quality of the included studies and synthesized results using a thematic analysis approach.ResultsWe included a total of nine studies. In four studies, the quality assessed was excellent and in five was moderate. We identified three themes that were of interest to both physicians and patients: information to reinforce anticoagulation use, balance of benefits and downsides, roles in decision-making and therapy management. Three additional themes were of interest to patients: knowledge and understanding, impact on daily life, and satisfaction with therapy. The main difficulties with the use of anticoagulant treatment according to physicians were the perceived uncertainty, need of individualised decision-making, and the feeling of delegated responsibility as their main concerns. The main factors for patients were the lack of information and understanding.ConclusionPhysicians’ and patients’ perceptions and attitudes might be potential factors in the underuse of treatment with vitamin K antagonists. Improving the quality and usability of clinical guidelines, developing tools to help with the decision-making, enhancing coordination between primary care and hospital care, and improving information provided to patients could help improve the underuse of anticoagulation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0574-0) contains supplementary material, which is available to authorized users.

Exploration of adherence and patient experiences with DOACs one year after switching from vitamin-K antagonists- insights from the switching study

“…Frequent testing is unavoidable in ensuring safe anticoagulation; however, the provision and setup of testing centres can be addressed. Similar issues have been raised in research elsewhere [24,25]. Capillary testing is a quick and easily applicable alternative to venous sampling.…”

“…To ensure optimal adherence to DOACs in patients prescribed additional medicines, perhaps efforts should be directed towards addressing adherence in the context of an entire regime rather than a single drug. This does not negate addressing knowledge deficits or patient beliefs surrounding their illness and anticoagulation in the consultation as this can be vital in ensuring good adherence [25,37]. Furthermore, research demonstrates AF patients value these discussions when considering anticoagulation [38,39].…”

“…Amongst those prescribed VKAs, research has demonstrated that although many patients find monitoring burdensome [22], a significant number derived confidence from monitoring, reassuring them of their control over their illness with many claiming they would be apprehensive about anticoagulants that required no such monitoring [23][24][25]. Research also shows patients rely heavily on the availability of specialist anticoagulation staff to manage their VKA therapy [23].…”

Association between subjective risk perception and objective risk estimation in patients with atrial fibrillation: a cross-sectional study

“…A recent qualitative systematic review postulated the lack of patient information as one of the most important reasons for vitamin K antagonists underuse. 41 Although Dantas et al 37 demonstrated that only minimal knowledge of patients is needed to allow acceptance of OAC, doctors should seek shared decisions. This is even more important, when evidence for drug treatment is marginal, 42 which is definitely not the case in patients with high risk scores for AF.…”

GPs’ understanding of the benefits and harms of treatments for long-term conditions: an online survey

“…Underestimation by clinicians of the benefits of anticoagulant therapy for stroke prevention in atrial fibrillation coupled with an overestimation of bleeding risk is known to be a factor in the under-use of this highly effective treatment. 25,26 It is no surprise that most GPs did not know the correct answers. The authors would not expect any individual to remember a high volume of precise figures.…”