Time in Therapeutic Range, Quality of Life and Treatment Satisfaction of Patients on Long-Term Warfarin for Non-Valvular Atrial Fibrillation: A Cross-Sectional Study

Abstract

Background:The use of warfarin in patients with non-valvular atrial fibrillation (NVAF) can be challenging. In this study, we evaluate the time in therapeutic range (TTR), health-related quality of life (HRQoL) and treatment satisfaction of patients on long-term warfarin for NVAF. The HRQoL and treatment satisfaction were compared based on the TTR.Methods:A cross-sectional study was conducted among patients on warfarin for NVAF who attended the anticoagulant clinic of a tertiary cardiology referral center in Sarawak from 1st June 2018 to 31st May 2019. Patients’ TTR was calculated by using Rosendaal technique, while their HRQoL and treatment satisfaction were assessed by using Short Form 12 Health Survey version 2 (SF12v2) and Duke Anticoagulant Satisfaction Scale (DASS), respectively. Results: A total of 300 patients were included, with mean TTR score of 47.0 ± 17.3%. The physical component summary (PCS) and mental component summary (MCS) score of SF-12v2 were 47.0 ± 9.0 and 53.5 ± 9.6, respectively. The total score for DASS was 55.2 ± 21.3, while the score for limitations (L), hassles and burdens (H&B) and positive psychological impacts (PPI) were 18.0 ± 10.0, 15.6 ± 9.1 and 21.6 ± 5.9, respectively. Seventy-three (24.3%) patients had good TTR (≥ 60%), with mean of 70.2 ± 8.7%; while 227 (75.5%) patients with poor TTR had significantly lower mean of 39.5 ± 11.9% (p = 0.006). There was no significant difference in the score of PCS (p = 0.150), MCS (p = 0.919) and each domain of SF-12v2 (p = 0.184 – 0.684) between good and poor TTR, except for social functioning (p = 0.019). The total DASS score was also not significantly different between group (p = 0.779). Similar non-significant difference was also reported in all the DASS sub dimensions (p = 0.502 – 0.699).Conclusions:Majority of the patients on long-term warfarin for NVAF in the current study have poor TTR. Their HRQoL and treatment satisfaction are independent of their TTR. Achieving a good TTR do not compromise the HRQoL and treatment satisfaction. Therefore, appropriate measures should be taken to optimise INR control, failing which direct oral anticoagulant therapy should be considered.

Sociodemographic, Clinical and Geriatric Characteristics Associated with Poor Atrial Fibrillation-Related Quality of Life in Older Adults with Atrial Fibrillation: A cross-sectional study

“…OACs are prescribed for patients with AF to decrease their risk of stroke [45]. While OACs do not directly affect patients' symptoms, it may provide relief for patients knowing they are at a much lower risk of developing stroke and therefore may improve their AFQoL [45,46]. Interestingly, we found that use of OACs was signi cantly associated with a higher odds of poor AFQoL.…”

“…Regarding COPD, a plausible reason for poorer AFQoL is that patients who experience frequent exacerbations of their COPD symptoms may be at an increased risk of experiencing frequent episodes of AF symptoms and potential rapid ventricular response [44]. OACs are prescribed for patients with AF to decrease their risk of stroke [45]. While OACs do not directly affect patients' symptoms, it may provide relief for patients knowing they are at a much lower risk of developing stroke and therefore may improve their AFQoL [45,46].…”

Risk of Major Bleeding and Thromboembolism in Asian Atrial Fibrillation Patients Using Non-vitamin K Oral Anticoagulants Versus Warfarin

“…A higher prevalence of low-dose NOAC prescription and lower TTR for warfarin treatment were found in the present cohort. Notably, these patterns of prescription seem to be common in clinical practice [28,29].…”

Warfarin—Is Self-Care the Best Care?

“…15 This attrition may reflect difficulty in managing and sustaining warfarin self-management, and raises the potential of study bias. Another study reported that health-related quality of life was independent of TTR, 16 highlighting the need for quality of life to be included as a separate outcome in warfarin self-care studies. One costeffectiveness study modeled VKA therapy self-testing/selfmanagement compared with usual care over 10 years.…”