Attitudes toward anticoagulant treatment among nonvalvular atrial fibrillation patients at high risk of stroke and low risk of bleed
Attitudes toward anticoagulant treatment among nonvalvular atrial fibrillation patients at high risk of stroke and low risk of bleed
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DOI：
10.2147/ppa.s106215
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发表时间：
2016-01-01
影响因子：
2.2
通讯作者：
Witt, Edward A.
中科院分区：
文献类型：
--
作者：
Crivera, Concetta;Nelson, Winnie W.;Witt, Edward A.
背景：房颤（AF）与卒中风险增加有关。抗凝剂（AC）治疗对房颤有效，但也会增加出血的风险。研究表明，很大一部分卒中风险高、出血风险低的房颤患者目前没有接受AC治疗。这项研究的目的是了解这些患者不接受这种可能挽救生命的治疗的原因。方法：通过一项自我报告在线调查，使用有效的仪器，对1184名自我报告诊断为房颤的美国成年人进行中风和出血风险筛查。在这些患者中，230例（19.4%）卒中风险高，出血风险低，目前未使用AC治疗，并被问及随访问题，以评估他们不治疗的原因，对治疗的态度和对给药方案的态度。结果：患者停止AC治疗的最常见原因是担心出血（27.8%）和其他医学问题（26.6%），而不开AC治疗的最常见原因是使用抗血小板治疗作为替代（57.1%）。在这两种情况下，对感知到的中风和/或出血风险的潜在错误决定也是一个因素。最后，对治疗和给药方案态度的最大影响因素分别是权威人士（如医生、药剂师）的指导和易用性。结论：结果表明，许多卒中高风险但出血风险低的房颤患者可能由于对风险的潜在错误认识而未接受AC治疗。该研究还发现，在做出治疗决定时，房颤患者对医生的信任高于成本等其他因素。医生加强对患者的风险和益处的教育可能是改善结果的一个简单策略。
Background: Atrial fibrillation (AF) is associated with an increased risk of stroke. Anticoagulant (AC) therapies are effective at treating AF, but carry with them an increased risk of bleed. Research suggests that a large proportion of AF patients who have high risk of stroke and low risk of bleeding are not currently receiving AC treatment. The goal of this study was to understand the reasons why these patients do not engage in this potentially life-saving treatment.Method: Through a self-report online survey, using validated instruments, 1,184 US adults who self-reported a diagnosis of AF were screened for the risk of stroke and bleed. Of these patients, 230 (19.4%) were at high risk of stroke, low risk of bleed, and not currently using an AC treatment, and were asked follow-up questions to assess their reasons for nontreatment, attitudes toward treatment, and attitudes toward dosing regimens.Results: The most common reasons patients stopped AC treatment were concerns regarding bleeding (27.8%) and other medical concerns (26.6%), whereas the most common reason cited for not being prescribed an AC in the first place was the use of antiplatelet therapy as an alternative (57.1%). In both cases, potentially erroneous decisions regarding perceived stoke and/or bleeding risk were also a factor. Finally, the largest factors regarding attitudes toward treatment and dosing regimen were instructions from an authority figure (eg, physician, pharmacist) and ease of use, respectively.Conclusion: Results suggest that many AF patients who are at high risk of stroke but at low risk of bleed may not be receiving AC due to potentially inaccurate beliefs about risk. This study also found that AF patients place trust in physicians above other factors such as cost when making treatment decisions. Increased education of patients by physicians on the risks and benefits may be a simple strategy to improve outcomes.