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Published on: February 26, 2013
Understanding the barriers to using oral anticoagulants among long-term aspirin users with atrial fibrillation - a
Vanessa W S Ng1, Chung-Wah Siu2, Patrick K C Chiu3
1Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China.
Insights
Patients with atrial fibrillation (AF) often don't use recommended oral anticoagulants (OACs) due to a lack of knowledge about AF and stroke prevention, and concerns about bleeding risks. Educational interventions are needed to improve understanding and treatment adherence.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- International guidelines recommend oral anticoagulants (OACs) for stroke prevention in atrial fibrillation (AF).
- OACs significantly reduce stroke risk with comparable bleeding risk to aspirin.
- Underuse of OACs in AF patients is a global issue, particularly in Asia.
Purpose of the Study:
- Identify barriers to prescribing and using OACs in long-term aspirin users with AF.
- Understand patient perspectives on OACs versus aspirin for stroke prevention.
Main Methods:
- Face-to-face semi-structured interviews with 14 AF patients on long-term aspirin.
- Thematic analysis of transcribed interview data.
Main Results:
- Key themes included: limited awareness of AF symptoms/diagnosis, poor understanding of AF and stroke prevention, patient involvement in decision-making, willingness to switch to OACs, and OAC regimen impact.
- Patients lacked awareness of AF and its stroke risks, limiting their treatment involvement.
- Concerns about OAC bleeding risks led some to prefer aspirin, citing manageable side effects.
- Warfarin's lifestyle requirements (diet, dosing) were perceived as barriers.
Conclusions:
- A significant knowledge gap exists regarding AF management among patients.
- Educational interventions can improve patient understanding of AF and its management.
- Enhanced understanding can promote active patient participation in treatment decisions.
Background:
Despite international treatment guidelines currently advocating oral anticoagulants (OACs) as the only appropriate stroke prevention therapy for patients with atrial fibrillation (AF) and evidence that OACs can greatly reduce the risk of stroke with similar risk of bleeding compared with aspirin, the underuse of OACs in patients with AF is common globally, especially in Asia. This study aimed to identify the barriers to prescribing and using OACs among long-term aspirin users with AF.
Method:
Face-to-face interviews were conducted with fourteen eligible patients with AF using a semi-structured interview guide. The interview recordings were transcribed verbatim and data was analyzed according to the principles of thematic analysis.
Results:
Five themes were developed: awareness of AF symptoms and diagnosis; knowledge and understanding of AF and stroke prevention therapy; role of decision-making in prescribing; willingness to switch from aspirin to OACs; and impact of OAC regimen on daily living. The majority of the patients were not aware of the symptoms and diagnosis of AF and only had a vague understanding of the illness and stroke prevention therapy, leading to their minimal involvement in decisions relating to their treatment. Some patients and their caregivers were particularly concerned about the bleeding complications from OACs and perceived aspirin to be a suitable alternative as they find the adverse effects from aspirin manageable and so preferred to remain on aspirin if switching to OACs was not compulsory. Lastly, the lifestyle modifications required when using warfarin, e.g. alternative dosing regimen, diet restriction, were seen as barriers to some patients and caregivers.
Conclusion:
The findings revealed patients' knowledge gap in AF management which may be targeted using educational interventions to improve patients' understanding of AF and its management and hence encourage active participation in the decision-making of their treatment in the future.
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