Stroke prevention in atrial fibrillation and ‘real world’ adherence to guidelines in the Balkan Region: The BALKAN-AF Survey

Potpara, Tatjana; Dan, Gheorghe‐Andrei; Trendafilova, Elina; Goda, A; Kušljugić, Zumreta; Manola, Šime; Musić, Ljilja; Musetescu, R.; Bădilă, Elisabeta; Mitić, Gorana; Paparisto, Vilma; Dimitrova, Elena; Polovina, Marija; Petranov, Stanislav L.; Djergo, Hortensia; Lončar, Daniela; Bijedić, Amira; Brusich, Sandro; Lip, Gregory Y. H.

doi:10.1038/srep20432

Cited by 49 publications

(64 citation statements)

References 25 publications

(40 reference statements)

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“…Oral anticoagulant agents are the mainstay of therapy in secondary prevention. Although numerous oral non-vitamin K antagonists have been developed in recent years, they have not yet replaced warfarin (vitamin K antagonist) (4,5). The efficacy of warfarin treatment is related to many variables such as socio-demographics, genetics, the pharmacokinetics of the drug, and patient adherence to the therapy.…”

Section: Introductionmentioning

confidence: 99%

Determination of Factors that Impact Adherence to Warfarin in Patients with Stroke

Tülek¹,

Dünya²,

Çiftçioğlu³

et al. 2019

tnd

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Objective: Oral anticoagulants are the mainstay in the secondary prevention of stroke. Adherence to drug is an important issue in preventing stroke. The aim of this study was to determine the adherence of patients with stroke to warfarin (anticoagulant agent) and to investigate the factors that may impact adherence. Materials and Methods: This descriptive cross-sectional study was conducted on patients admitted to an outpatient neurology clinic of a tertiary hospital in Istanbul. A total of 99 patients with stroke who were under warfarin treatment for at least 6 months prior to the study were enrolled in the study. Patients were assessed in terms of sociodemographic characteristics, adherence to and knowledge regarding the drug, anxiety and depression, mental and functional state and quality of life using validated scales. Results: The mean adherence score of the patients was 3.3±1.1 (0-4). The reported adherence rates were not considered as low in our sample given that 42% had poor knowledge. Significant negative correlations were determined between drug adherence and age, number of risk factors, and duration of anticoagulant use (r=-0.39, r=-0.33, r=-0.52, p<0.001, respectively). The mean drug adherence scores were lower in patients who had experienced drug-related adverse effects compared with those that did not (p=0.018). Significant correlations were found between the adherence scale and all other variables (p<0.05). Multiple linear regression analysis revealed that drug adherence was predicted by experiencing adverse effects, knowledge regarding the drug, and depression. Conclusion: Knowledge regarding the use of warfarin was inadequate in our patients, whereas adherence was reported not to be inadequate. The most influential factors that may impact adherence were adverse effects, knowledge, and depression. Healthcare professionals should be aware of patients who have risk factors for non-adherence.

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Section: Introductionmentioning

confidence: 99%

Determination of Factors that Impact Adherence to Warfarin in Patients with Stroke

Tülek¹,

Dünya²,

Çiftçioğlu³

et al. 2019

tnd

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“…The survey was conducted in 7 countries in the Balkan region (ie in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, Romania and Serbia) comprising approximately 40 million inhabitants. The survey was designed and conducted by the Serbian Atrial Fibrillation Association (SAFA), a nonprofit multidisciplinary association of expert physicians involved in AF management and research, and the BALKAN‐AF study protocol has been previously reported in detail …”

Section: Methodsmentioning

confidence: 99%

“…The survey was designed and conducted by the Serbian Atrial Fibrillation Association (SAFA), a nonprofit multidisciplinary association of expert physicians involved in AF management and research, and the BALKAN-AF study protocol has been previously reported in detail. 5 The study has been announced to the National Cardiology Societies/relevant Working Groups in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Former Yugoslav Republic Macedonia, Montenegro, Romania, Serbia and Slovenia. In the participating countries, the study has been approved by the National and/or local Institutional Review Board and, as per local requirements, a signed patient informed consent has been obtained before enrolment.…”

Section: Study Design and Patient Selectionmentioning

confidence: 99%

Stroke prevention in elderly patients with non‐valvular atrial fibrillation in the BALKAN‐AF survey

Potpara

Simović

Pavlović

et al. 2020

Eur J Clin Investigation

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Background Atrial fibrillation (AF) is common amongst the elderly, but this group tends to be suboptimally treated. Limited data are available on the stroke prevention strategies in the elderly, especially in the Balkan region. Aim We investigated the use of oral anticoagulant therapy (OAC) amongst elderly AF patients in clinical practice in the Balkan region. Method A 12‐week prospective snapshot survey (2014‐2015) of consecutive non‐valvular AF patients was conducted in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, Romania and Serbia. Data were collected via an electronic case report form. Results Of 2671 patients, 418 (15.6%) were ≥80 years old. Overall, OAC was used in 1965 patients (73.6%). Compared with younger patients, the elderly (age ≥ 80) had a higher mean CHA2DS2‐VASc score (3.22 ± 1.71 vs 4.89 ± 1.35, P < .001) and more often a HAS‐BLED score of ≥3 (n = 198 [47.0%] vs n = 625 [27.3%], P < .001), but were less likely to receive OAC (n = 269 [64.4%] vs n = 1696 [75.3%], odds ratio [OR] 0.91; 95%CI 0.86‐0.97, P = .003). There was no significant association between OAC use and mean CHA2DS2‐VASc (OR 0.86; 95%CI 0.75‐1.00, P = .053) or HAS‐BLED score (OR 1.21; 95%CI 0.81‐1.81, P = .349) in the elderly. Conclusion In the BALKAN‐AF Survey, elderly AF patients were less likely to receive the guideline‐adherent treatment despite their less favourable risk profile. Since OAC nonuse among the elderly was not associated with increased HAS‐BLED score, factors other than patients’ risk profile could influence the implementation of guideline‐adherent treatment for thromboprophylaxis in the elderly AF patients.

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“…Recent guidelines are preferring use of Rivaroxaban over warfarin 14,15 and this strategy is implemented although at a modest level in a number of countries 16 . In our study the number of patients on Rivaroxaban was very low probably because of the common documented barriers like concerns of bleeding 17 and some others reasons like cost to translate guidelines recommendations into clinical practice 18 .…”

Section: Discussionmentioning

confidence: 99%

Use of Novel Oral Anticoagulants (NOACs) in Patients with Risk of Stroke in Non Valvular Atrial Fibrillation (AF)

Farooq

Hashim

Karim

et al. 2017

Int. j. endorsing health sci. res.

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Background: Warfarin was used for decades to prevent stroke in high risk AF patients, recent guidelines and published data is recommending use of NOACs like Rivaroxaban as an alternative to Warfarin, Its use is increasing world over because of its predictable action, less food and drug interaction and no need of monitoring for dose adjustments, considering these facts we planned to conduct a study to see the frequency of use of Rivaroxaban in our local population of AF patients with risk of stroke calculated by CHA2DS2-VASc score. Method: This cross-sectional study was done at National Institute of Cardiovascular disease (NICVD) from May 2017 to September 2017 included 137 non-valvular AF patients with high risk of stroke calculated by applying CHA2DS2-VASc score more than or equal to 2. Clinical details and information about anticoagulant medications prescribed to them was also obtained. SPSS 19 was used for the analysis, descriptive statistics such as mean ±SD, frequency and percentages were calculated. Z-test, t-test, and chi-square test were used for the assessment and comparison of data. Two sided p-value of 0.05 was considered for statistical significance. Results: Total 137 patient were included 50.4% (69) were male, 104 (75.91%) out of 137 were on Anticoagulant therapy, with 86 (62.77%) were on Warfarin and only 18 (13.14%) were taking Rivaroxaban. Conclusion: Our study showed very small percentage of non valvular AF patients with risk of stroke were prescribed Rivaroxaban. It's important to update our treating Physicians about this novel agent which is shown to be equally effective and safe in comparison to warfarin, and easy to prescribe without monitoring to reduce stroke risk.

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Stroke prevention in atrial fibrillation and ‘real world’ adherence to guidelines in the Balkan Region: The BALKAN-AF Survey

Cited by 49 publications

References 25 publications

Determination of Factors that Impact Adherence to Warfarin in Patients with Stroke

Determination of Factors that Impact Adherence to Warfarin in Patients with Stroke

Stroke prevention in elderly patients with non‐valvular atrial fibrillation in the BALKAN‐AF survey

Use of Novel Oral Anticoagulants (NOACs) in Patients with Risk of Stroke in Non Valvular Atrial Fibrillation (AF)

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