Physical, cognitive, and psychosocial conditions in relation to anticoagulation satisfaction among elderly adults with atrial fibrillation: The SAGE‐AF study

Abstract

Background Successful anticoagulation is critical for stroke prevention in adults with atrial fibrillation (AF). Anticoagulation satisfaction is a key indicator of treatment success. While physical, cognitive, and psychosocial limitations are common in elderly AF patients, their associations with anticoagulation satisfaction are unknown. Objective Examine whether anticoagulation satisfaction differs among AF patients with and without physical, cognitive, and psychosocial conditions. Methods The study comprised AF patients greater than or equal to 65 years old who were prescribed an oral anticoagulant (warfarin 57%; direct oral anticoagulant [DOAC] 43%). Frailty, cognitive function, social support, depressive symptoms, vision, hearing, and anxiety were assessed using validated measures. Anticoagulation satisfaction was measured using the anticlot treatment scale. Results Participants (n = 1037, 50% female) were on average 76 years old. The following conditions were prevalent: frailty (14%), cognitive impairment (42%), social isolation (13%), vision impairment (35%), hearing impairment (36%), depression (29%), and anxiety (24%). Average anticlot treatment burden scale was 55 out of 60 (lower burden scales indicating higher perceived burden). Patients with high perceived burden were older, more likely to be female, and receive warfarin. After adjusting for confounders, visual impairment (adjusted odds ratio [95% confidence interval]: 1.7 [1.2‐2.4]), depressive symptoms (2.4 [1.6‐3.7]), and anxiety (1.8 [1.2‐2.7]) were significantly associated with high perceived burden. Different conditions were associated with high perceived burden in warfarin vs DOAC users. Conclusion Physical, cognitive, and psychosocial limitations are prevalent and associated with high perceived anticoagulation burden among elderly AF adults. These conditions merit consideration in anticoagulation prescribing.

Factors Associated With Patient Engagement in Shared Decision-Making for Stroke Prevention Among Older Adults with Atrial Fibrillation

“…Using data from the ongoing SAGE (Systematic Assessment of Geriatric Elements)-AF study, (17,18) we examined the extent to which older men and women with nonvalvular AF (NVAF) were engaged in the decision-making process to take OAC for stroke prevention. We hypothesized that patient engagement in SDM would be modest, with a need for better patient engagement, and that advancing age would be inversely related with being part of this process.…”

“…As part of an ongoing prospective study, adults aged 65 years and older with AF were recruited from five medical centers in Massachusetts and Georgia between 2015 and 2018. (17,18) The eligibility criteria for enrollment in SAGE-AF included: a) having a CHA2DS2-VASc (congestive heart, failure, hypertension, age [>75 years], diabetes, stroke, vascular disease, age [65 to 74 years], female gender) (19) score ≥2, and b) having a scheduled ambulatory care visit at any of the study clinic sites. Participants were not included in this study if they were unable to provide written informed consent, had a documented contraindication to OAC therapy (i.e., history of intracranial hemorrhage, mechanical heart valve, end-stage renal disease) or were on OAC for different indications other than AF, had a scheduled procedural intervention that was associated with an increased risk for bleeding, were non-English speakers, or were prisoners.…”

Satisfaction With Oral Anticoagulants Among Patients With Atrial Fibrillation: A Prospective Observational Study

“…[3][4][5] However nonadherence with OAC therapy is common and has been significantly associated with poor outcomes such as ischemic stroke, systemic embolism, higher healthcare costs, and higher mortality rate compared to adherent patients. 6,7 Satisfaction has been associated with various outcomes, including adherence to therapy in a range of diseases. 8,9 Studies on patients with AF on OAC therapy have also identified treatment satisfaction as an important psychosocial determinant of adherence to therapy, with lower satisfaction with OAC treatment being a significant predictor of stroke/systemic embolism, mediated by OAC nonadherence and non-persistence.…”

“…8,9 Studies on patients with AF on OAC therapy have also identified treatment satisfaction as an important psychosocial determinant of adherence to therapy, with lower satisfaction with OAC treatment being a significant predictor of stroke/systemic embolism, mediated by OAC nonadherence and non-persistence. 7,[10][11][12][13] In patients with AF on direct oral anticoagulants (DOACs), low satisfaction with benefits of therapy is independently associated with a three-fold increase in the incidence of stroke. 11 Reasons for lack of satisfaction include factors related to the patient and to the OAC itself such as the need for routine blood work monitoring, treatment-associated bleeding, drug and dietary interactions, dosing schedule, and cost.…”

“… 3 , 4 , 5 However, nonadherence to OAC therapy is common and has been significantly associated with poor outcomes such as ischemic stroke, systemic embolism, higher healthcare costs, and a higher mortality rate, compared with those for adherent patients. 6 , 7 …”