Quality of life in patients with nonvalvular atrial fibrillation treated with oral anticoagulants

Abstract

Objectives: Health-related quality of life (HRQL) is a key factor in making anticoagulant treatment decisions. The objective of this study was to assess the HRQL of patients with nonvalvular atrial fibrillation by treatment type: direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). Methods: We carried out a cross-sectional observational study with clinical practice data, gathering demographic and clinical variables. HRQL was measured using the 5-level 5dimension EuroQol questionnaire (EQ-5D-5L). Differences between the study groups in HRQL as measured by the EQ-5D-5L were analyzed using two-part multivariate regression models. First, using logistic regression, the adjusted probability, p(x), of having perfect health was estimated in each subgroup. Secondly, generalized linear models were used to estimate mean disutility values, w(x), in a population that does not have perfect health, i.e. utility less than 1 or 1-w(x). Results: We recruited 333 patients, of whom 126 were on DOACs and 207 on VKAs. A significant difference was observed in the EQ-5D-5L anxiety/depression dimension, with a higher percentage of patients classified in the 'no problems' category in the DOAC group. The same type of analysis did not identify significant differences in any of the other dimensions (mobility, self-care, usual activities or pain/discomfort). Discussion: In the multivariate model, utility was significantly higher in the DOAC group than in the VKA group, although the difference was small (0.0121). This difference is attributable to patients on DOACs having less anxiety/depression. Conclusion: Patients treated with DOACs report a slightly better quality of life than those treated with VKAs.

Shared Decision-Making for Drug-Drug Interactions: Formative Evaluation of an Anticoagulant Drug Interaction

“…Another limitation is that the clinical scenario required dyads to role-play a scenario that may not occur in clinical practice, where a patient is seeking advice from the physician about treating pain while on an anticoagulant. While this scenario may be infrequent in most practice settings, previous studies have found this to occur in up to 25% of patients receiving warfarin [ 2 , 3 ]. Furthermore, many physicians in the study indicated they were aware of the interaction when researchers explained the scenario prior to the simulated visit.…”

“…Warfarin is well known for having a multitude of drug-drug interactions (DDIs), with many avoided through health care provider awareness. However, studies found that up to 24% of people taking warfarin also received a prescription for nonsteroidal anti-inflammatory drugs (NSAIDs), and almost 50% of patients on warfarin have some form of ongoing pain [ 2 , 3 ]. Concomitant use of a NSAID and warfarin increases the risk of bleeding [ 4 , 5 ].…”

Comparison of the effects of left atrial appendage closure and oral anticoagulants in preventing stroke in patients with non-valvular atrial fibrillation

“…What still needs to be considered when using anticoagulant drugs is the increased risk of bleeding, especially major bleeding that may require hospitalization, blood transfusion, and surgical intervention, or major bleeding involving important anatomical locations, such as intracranial hemorrhage, which is significantly related to increased mortality. [ 16 ] Therefore, not all NVAF patients are suitable targets for anticoagulation, and some NVAF patients are only suitable for short-term anticoagulation. Therefore, the study of non-pharmacological treatment of NVAF patients is also crucial, because the thrombosis of NVAF patients is most common in the left atrial appendage, so LAAO has become a potential non-pharmacological treatment for stroke prevention in NVAF patients.…”

“…Numerous studies have also confirmed that standard anticoagulation therapy can significantly reduce the risk of embolism in NVAF patients. What still needs to be considered when using anticoagulant drugs is the increased risk of bleeding, especially major bleeding that may require hospitalization, blood transfusion, and surgical intervention, or major bleeding involving important anatomical locations, such as intracranial hemorrhage, which is significantly related to increased mortality [16] . Therefore, not all NVAF patients are suitable targets for anticoagulation, and some NVAF patients are only suitable for short-term anticoagulation.…”

Situación actual de los anticoagulantes orales de acción directa en atención primaria de España. Posicionamiento de SEMERGEN en 2023

“…Gabilondo (2021) 78 Estudio transversal que incluyó 333 pacientes, de los que 126 tomaban ACOD y 207 AVK. El tratamiento con ACOD se asoció con menos ansiedad y depresión Domínguez-Erquicia (2021) 79 Registro multicéntrico (3 áreas sanitarias de España) de pacientes nonagenarios con FA no valvular anticoagulados con AVK o ACOD entre 2013 y 2017.…”