Veterans Perceptions of Satisfaction and Convenience with Anticoagulants for Atrial Fibrillation: Warfarin versus Direct Oral Anticoagulants.
Veterans Perceptions of Satisfaction and Convenience with Anticoagulants for Atrial Fibrillation: Warfarin versus Direct Oral Anticoagulants.
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DOI：
10.2147/ppa.s279621
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发表时间：
2020
影响因子：
2.2
通讯作者：
Sullivan JL
中科院分区：
文献类型：
--
作者：
Mull HJ;Shin MH;Engle RL;Linsky AM;Kalver E;Lamkin R;Sullivan JL
房颤（AFib）与高发病率和死亡率相关。传统上，AFib用华法林治疗，但最近的证据表明患者可能倾向于直接口服抗凝剂（DOAC）。偏好的变化是常见的，我们在退伍军人健康管理局（VA）内探讨了患者对DOAC与华法林的满意度和便利性的看法。我们对居住在新英格兰、年龄≥65岁、诊断为AFib并在2018财年积极服用抗凝药物的退伍军人进行了一项横断面调查，即抗凝治疗感知问卷2（PACT-Q2）。接受调查的患者随机选择华法林（n=200）或DOAC（n=200）。一个选择的调查受访者同意后续的半结构化访谈（n=16），以进一步调查的满意度和方便的看法。在400例患者中，187例完成了PACT-Q2调查（49%接受DOAC; 51%接受华法林）。DOAC的便利性评分显著高于华法林（87.6，SD 13.5 vs 81.1，SD 18.8; p=0.007）;满意度无差异（64.2，SD 20.5 SD，华法林vs 67.3，SD 19.4，DOAC）。访谈结果显示，参与者认为他们的治疗是方便的。然而，参与者表达了与服用华法林或DOAC的便利性相关的挑战，例如华法林使用者必须遵循饮食建议或DOAC使用者希望进行一些额外的监测以回答问题或担忧。总体而言，华法林和DOAC使用者对持续监测方法表示满意，尽管少数DOAC使用者对监测频率表示不确定。对于大多数参与者来说，对副作用的担忧并没有因抗凝剂类型而异，也没有影响满意度。我们的调查和访谈结果显示，患者对DOAC和华法林的满意度和便利性的看法各不相同。虽然DOAC越来越多地用于AFib，但一些退伍军人认为定期随访华法林是有利的。我们的研究结果证明了以患者为中心的决策在VA患者人群中AFib治疗中的重要性。
Atrial fibrillation (AFib) is associated with high morbidity and mortality. Traditionally, AFib was treated with warfarin, yet recent evidence suggests patients may favor direct oral anticoagulants (DOACs). Variation in preferences is common and we explored patients’ perceptions of satisfaction and convenience of DOACs versus warfarin within the Veterans Health Administration (VA). We administered a cross-sectional survey, the Perception of Anticoagulant Treatment Questionnaire 2 (PACT-Q2), to Veterans residing in New England, age ≥65, diagnosed with AFib, and actively taking anticoagulant medication in fiscal year 2018. Survey recipients were randomly selected among patients on warfarin (n=200) or DOACs (n=200). A selection of survey respondents agreed to a follow-up semi-structured interview (n=16) to further investigate perceptions of satisfaction and convenience. Of 400 patients, 187 completed the PACT-Q2 survey (49% on DOACs; 51% on warfarin). DOACs received significantly higher convenience ratings than warfarin (87.6, SD 13.5 vs 81.1, SD 18.8; p=0.007); there was no difference in satisfaction (64.2, SD 20.5 SD, warfarin vs, 67.3, SD 19.4, DOACs). Interview results showed that participants perceived their treatment to be convenient. However, participants expressed challenges related to the convenience of taking warfarin or DOACs, such as warfarin users having to follow dietary recommendations or DOAC users desiring some additional monitoring to answer questions or concerns. Overall, warfarin and DOAC users reported satisfaction with ongoing monitoring methods, although a few DOAC users expressed uncertainties with the frequency of monitoring. For most participants, concerns about side effects did not differ by anticoagulant type nor affect satisfaction. Our survey and interview results showed variable patient satisfaction and perceptions of convenience with both DOACs and warfarin. Although DOACs are increasingly prescribed for AFib, some Veterans felt that regular follow-up on warfarin was advantageous. Our findings demonstrate the importance of patient-centered decision-making in AFib treatment in the VA patient population.