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Published on: February 26, 2013
Comparing Patient and Physician Risk Tolerance for Bleeding Events Associated with Anticoagulants in Atrial
Ken Okumura1, Hiroshi Inoue2, Masahiro Yasaka3
1Division of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki-city, Aomori, Japan.
Insights
Patient and physician preferences for anticoagulant benefits and risks in atrial fibrillation (AF) varied by country. Japanese patients were more tolerant of bleeding risks than US patients, highlighting cultural differences in risk perception.
Area of Science:
- Cardiology and Thrombosis
- Health Economics and Outcomes Research
Background:
- Atrial fibrillation (AF) increases stroke risk, necessitating anticoagulation.
- Anticoagulants carry bleeding risks, leading to subtherapeutic treatment in some AF patients.
- Understanding patient and physician risk-benefit perceptions is crucial for optimal anticoagulation management.
Purpose of the Study:
- To quantify the perceived importance of anticoagulant benefits versus bleeding risks in patients with AF.
- To compare patient and physician preferences across the United States and Japan.
- To identify potential disparities in risk tolerance influencing treatment decisions.
Main Methods:
- A discrete-choice experiment was employed to elicit preferences.
- Surveys were administered to 186 patients and 107 physicians in the US.
- Surveys were administered to 152 patients and 164 physicians in Japan.
Main Results:
- Japanese patients showed less aversion to bleeding risks compared to US patients.
- Physicians in both countries did not differentiate between disabling and nondisabling stroke prevention.
- US patients were less tolerant of bleeding risk for nondisabling stroke prevention than physicians; Japanese patients were more tolerant of bleeding risks for preventing both types of strokes than physicians.
Conclusions:
- US patient and physician preferences for anticoagulant benefits and risks were similar.
- US and Japanese physician preferences regarding stroke risk were comparable.
- Significant differences existed between patient and physician preferences in Japan.
Objectives:
Atrial fibrillation (AF) is a factor in the development of thrombi that can lead to ischemic strokes. Anticoagulants are crucial in preventing strokes among patients with AF but are associated with bleeding risks. Recent studies have shown that despite anticoagulants' efficacy in stroke prevention, many patients with AF receive subtherapeutic levels of anticoagulation because of concerns about bleeding. Of particular interest is to quantify the perceived relative importance of treatment-related benefits and risks and how these perceptions vary between patients and physicians in different countries.
Methods:
Patients' and physicians' preferences were elicited using a discrete-choice experiment. We evaluated disagreements in preferences for the benefits and risks of anticoagulants.
Results:
A total of 186 patients with AF and 107 physicians in the United States completed the survey. In Japan, 152 patients and 164 physicians completed the same survey. Japanese patients were relatively less averse than US patients to bleeding risks. Physicians in both countries did not distinguish between nondisabling and disabling strokes. US patients were less tolerant than physicians of nonmajor clinically relevant bleeding risk when this risk was a consequence of preventing nondisabling strokes. Japanese patients were generally more tolerant than physicians of bleeding risks when the risks were consequences of preventing both nondisabling and disabling strokes.
Conclusions:
Overall, preferences for anticoagulant benefits and risks were not statistically different between patients and physicians in the United States, nor were there differences in preferences for different stroke risks between physicians in the United States and Japan; however, preferences were different between patients and physicians in Japan.
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