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Al-Jabi SW, Dalu AA, Koni AA, Khdour MR, Taha AA, Amer R, Zyoud SH. The relationship between self-efficacy and treatment satisfaction among patients with anticoagulant therapy: a cross-sectional study from a developing country. Thromb J 2022; 20:15. [PMID: 35379235 PMCID: PMC8978358 DOI: 10.1186/s12959-022-00374-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/23/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Thromboembolic events are a common complicated health problem. Although anticoagulants have several positive effects on these conditions, they also have several characteristics that strongly affect compliance and satisfaction. The purpose of this investigation is to explore the association between treatment satisfaction and self-efficacy in a sample of patients using anticoagulation therapy and determine the influence of sociodemographic and clinical factors on both aspects. METHODS This was a cross-sectional exploratory study carried out in Palestine. The Arabic version of the Anti-Coagulant Treatment Satisfaction Scale (ACTS) assessed treatment satisfaction. In addition, the Arabic version of the 6-Item Self-Efficacy for Managing Chronic Diseases (SES6C) was used to assess self-efficacy. RESULTS A total of 300 patients using anticoagulants (average age 51.95 and SD 17.98) were included. There is a modest correlation between treatment satisfaction and self-efficacy (r = 0.345; p < 0.001). The mean and median self-efficacy scores were 38.41 ± 9.88 and 39.00 (interquartile range: 33.00-46.00), respectively. Overall, patients reported a moderate burden and benefit score. The mean and median of the acting burden were 43.30 ± 10.45, and 43.30 (interquartile range: 36.00 to 51.00), respectively. The results showed that young age, higher education, employment, use of fewer medications, and having fewer diseases were significantly associated with higher self-efficacy behaviors. The results also showed that new oral anti-coagulants (NOACs) had a higher degree of self-efficacy and ACTS benefit scores (41.00 (33.75-47.00), p = 0.002; 13.00 (12.00-15.00), p < 0.001, respectively), than vitamin k antagonists (VKA). CONCLUSIONS The results demonstrated a significant relationship between treatment satisfaction and self-efficacy, and certain sociodemographic and clinical characteristics influence both. We found that there is a higher degree of self-efficacy and treatment satisfaction among patients who use NOACs than those who use UFH / VKA. Therefore, patients should be motivated to increase their knowledge about anticoagulant therapy. Healthcare providers should play an active role in educating patients, increasing their self-esteem, and awareness about anticoagulant drugs. Importantly, this study was an explanatory one, and it includes a low proportion of patients with venous thromboembolism. This encourages future research on a large scale of patients, considering the indications of anticoagulant therapy.
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Affiliation(s)
- Samah W. Al-Jabi
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Amal Abu Dalu
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Amer A. Koni
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Division of Clinical Pharmacy, Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Maher R. Khdour
- grid.16662.350000 0001 2298 706XFaculty of Pharmacy, Al-Quds University, Abu Deis, Jerusalem, 51000 Palestine
| | - Adham Abu Taha
- grid.11942.3f0000 0004 0631 5695Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Department of Pathology, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Riad Amer
- grid.11942.3f0000 0004 0631 5695Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Department of Hematology and Oncology, An-Najah National University Hospital, Nablus, 44839 Palestine
| | - Sa’ed H. Zyoud
- grid.11942.3f0000 0004 0631 5695Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
- grid.11942.3f0000 0004 0631 5695Clinical Research Center, An-Najah National University Hospital, Nablus, 44839 Palestine
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Guerrero-Márquez FJ, Sainz-Hidalgo I, Cristobo Sainz P, Sigler Vilches I, Avilés Toscano A, Soto-Espinosa de Los Monteros B. [Effectiveness of the EQ-5D and CRES-4 questionnaire for assessing the impact on the quality of life of patients and the level of satisfaction after exchanging dicumarinics for edoxabán: Real-life experience based on a multicentre study]. Med Clin (Barc) 2021; 157:530-534. [PMID: 33059936 DOI: 10.1016/j.medcli.2020.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Atrial fibrillation and anticoagulation decrease the quality of life of patients. The aim of this study is to assess the quality of life and the degree of satisfaction after changing from VKA to edoxaban anticoagulants. MATERIAL AND METHODS Prospective, multicentre study, including 105 patients in dicumarinic anticoagulant treatment replaced by edoxaban. Their quality of life was evaluated before and after using the EQ-5D questionnaire, and the degree of satisfaction with CRES-4 scale. RESULTS Average 75 years, CHA2DS2VASC3,5 and HASBLED2,1; thromboembolic events and clinically relevant bleeding during follow-up <1%. EQ-5D showed a significant overall improvement in the mobility and anxiety parameters (P=.023, 95%CI: .0175-.23; P=.019, 95%CI:=.028-.31). The CRES-4 questionnaire showed satisfaction with the therapist of 95%, a positive impact on life of 73% and a negative impact of 3.8%. The emotional state attributed to the change in treatment improved (41% vs 69.5%, P=.0001). The final score of the CRES-4 weakly correlated with the emotional situation of the EQ-5D questionnaire. CONCLUSIONS The change of anticoagulant for edoxaban improves the quality of life and the degree of patient satisfaction, and the EQ-5D and CRES-4 quality of life questionnaires can be used complementarily.
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Affiliation(s)
| | - Ignacio Sainz-Hidalgo
- Área del Corazón, Servicio de Cardiología, Hospital Virgen del Rocío, Sevilla, España
| | - Pablo Cristobo Sainz
- Área del Corazón, Servicio de Cardiología, Hospital Virgen del Rocío, Sevilla, España
| | | | - Alberto Avilés Toscano
- Departamento de Cardiología, Servicio de Medicina Interna, Hospital de la Serranía, Ronda, Málaga, España
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Shilbayeh SAR, Ismail SAER. Translation, Pilot Psychometric Validation, and Comparative Performance of the Arabic Version of the Anti-Clot Treatment Scale (ACTS). J Pharm Bioallied Sci 2020; 13:61-68. [PMID: 34084049 PMCID: PMC8142906 DOI: 10.4103/jpbs.jpbs_395_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 11/04/2022] Open
Abstract
Background Anticoagulation management is a complex process that is managed through careful monitoring, and patient satisfaction has a significant impact. Given the lack of a valid and reliable tool in Arabic to examine patient satisfaction, the present study aimed to translate and examine some of the psychometric properties of the Anti-Clot Treatment Scale (ACTS) among Saudi patients. Materials and Methods This was a cross-sectional, methodological study conducted among patients receiving warfarin. The questionnaire was subjected to translation by using a multistep method. The final Arabic translated version of the ACTS underwent face and content validity assessments by independent experts to ensure its conceptual equivalence to the original English version. Subsequently, pilot testing of convergent, discriminant, and criterion validities were examined. Results Overall, 136 patients participated in the study. All patients were asked to complete the generic Treatment Satisfaction Questionnaire for Medication (TSQM) alongside the ACTS tool. Convergent validity analyses revealed statistically significant positive correlations (p < 0.01) between the ACTS subscales and the four TSQM subdomains, as reflected by the Spearman correlation coefficient (r). Interestingly, the strongest correlations were observed between ACTS Burdens and the TSQM convenience domain (r = 0.61) and between ACTS Benefits and the TSQM effectiveness satisfaction score (r = 0.58). Similarly, discriminant validity was evidenced by moderate to high significant loading of all 12 items on each of their corresponding ACTS subscales. Conclusion These findings of adequate validity support the use of the ACTS in Saudi patients receiving anticoagulant medications to measure their specific satisfaction levels with this type of therapy. However, future research addressing the clinical impact of ACTS scores in the Saudi population is needed.
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Affiliation(s)
- Sireen Abdul Rahim Shilbayeh
- Department of Pharmaceutical Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University (PNU), Riyadh, Saudi Arabia
| | - Sahar Abd El Rahman Ismail
- Department of Computer Science, College of Computer and Information Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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Shilbayeh SAR, Ibrahim AA. The anti-clot treatment scale (ACTS): validation of the translated Arabic version among patients undergoing warfarin therapy in Saudi Arabia. Health Qual Life Outcomes 2020; 18:215. [PMID: 32631346 PMCID: PMC7339378 DOI: 10.1186/s12955-020-01471-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Long-term anticoagulation therapy, particularly with warfarin, is usually associated with poor adherence and low patient satisfaction. However, previous studies have highlighted the possibility that individual perceptions of warfarin differ according to cultural practices. This study validated the psychometric properties of the translated Arabic version of the Anti-Clot Treatment Scale (ACTS) for patients on warfarin therapy in Saudi Arabia. Methods A cross-sectional multicenter study was conducted at the three main medical centers in Riyadh. Stratified sampling was employed to recruit Arabic-speaking patients who had been taking warfarin for a minimum of 3 months for any indication. The patients completed the specific ACTS along with the generic Treatment Satisfaction Questionnaire for Medication (TSQM 1.4) at two clinic visits. The psychometric performance of the ACTS was evaluated using well-established criteria: feasibility, reliability, and validity. Results One hundred thirty-six patients participated in the study (mean age: 50.68 ± 14.6 years; range: 19–97). Overall, the patients reported moderate Burdens and Benefits scores (44 ± 9.9 and 11.92 ± 2.4, respectively) compared to the reference range for each subscale (12–60 and 3–15, respectively); however, they reported lower Burdens scores than other populations. Consistent with the original ACTS validation study, the criteria for acceptability (data targeting, floor/ceiling effects, and skewness) were satisfied; in fact, the Arabic version exhibited better item- and scale-level distributions of data than versions in other languages. The ACTS subscales also demonstrated satisfactory test-retest reliability with significant intraclass correlation coefficients ((ICC ≥ 0.5); p < 0.001) and good internal consistency (all Cronbach’s alpha values exceeded 0.7). Exploratory factor analysis supported the 2-factor loading model. Interestingly, the Arabic version exhibited greater convergent validity with the TSQM subdomains (r = 0.61). Conclusions This study provides convincing evidence that the Arabic versions of both the ACTS Burdens and ACTS Benefits scales are equivalent to other versions in terms of psychometric performance, as measured using reliability and validity criteria. These properties support the great potential of the Arabic ACTS to accurately reflect patient satisfaction, identify aspects of treatment that need improvement in clinical practice, and compare treatment satisfaction across different anticoagulant therapies or cultures in research.
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Affiliation(s)
- Sireen Abdul Rahim Shilbayeh
- Department of Pharmaceutical Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia.
| | - Alnada Abdalla Ibrahim
- Department of Pharmaceutical Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh, 11671, Saudi Arabia
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Ungar L, Rodriguez F, Hellkamp AS, Becker RC, Berkowitz SD, Breithardt G, Fox KAA, Hacke W, Halperin JL, Hankey GJ, Nessel CC, Singer DE, Patel MR, Piccini JP, Mahaffey KW. Patient-Reported Satisfaction and Study Drug Discontinuation: Post-Hoc Analysis of Findings from ROCKET AF. Cardiol Ther 2019; 8:283-295. [PMID: 31376090 PMCID: PMC6828909 DOI: 10.1007/s40119-019-00146-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Patient-reported outcomes (PROs) and satisfaction endpoints are increasingly important in clinical trials and may be associated with treatment adherence. In this post hoc substudy from ROCKET AF, we examined whether patient-reported satisfaction was associated with study drug discontinuation. METHODS ROCKET AF (n = 14,264) compared rivaroxaban with warfarin for prevention of stroke and systemic embolism in patients with atrial fibrillation. We analyzed treatment satisfaction scores: the Anti-Clot Treatment Scale (ACTS) and Treatment Satisfaction Questionnaire for Medication version II (TSQM II). We compared satisfaction with study drug between the two treatment arms, and examined the association between satisfaction and patient-driven study drug discontinuation (stopping study drug due to withdrawal of consent, noncompliance, or loss to follow-up). RESULTS A total of 1577 (11%) patients participated in the Patient Satisfaction substudy; 1181 (8.3%) completed both the ACTS and TSQM II 4 weeks after starting study drug. Patients receiving rivaroxaban did not experience significant differences in satisfaction compared with those receiving warfarin. During a median follow-up of 1.6 years, 448 premature study drug discontinuations occurred (213 rivaroxaban group; 235 warfarin group), of which 116 (26%) were patient-driven (52 [24%] rivaroxaban group; 64 [27%] warfarin group). No significant differences were observed between satisfaction level and rates of patient-driven study drug discontinuation. CONCLUSIONS Study drug satisfaction did not predict rate of study drug discontinuation. No significant difference was observed between satisfaction with warfarin and rivaroxaban, as expected given the double-blind trial design. Although these results are negative, the importance of PRO data will only increase, and these analyses may inform future studies that explore the relationship between drug-satisfaction PROs, adherence, and clinical outcomes. CLINICALTRIALS.GOV: NCT00403767. FUNDING The ROCKET AF trial was funded by Johnson & Johnson and Bayer.
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Affiliation(s)
- Leo Ungar
- University of California Irvine Medical Center, Orange, CA, USA.
| | - Fatima Rodriguez
- Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, CA, USA
| | - Anne S Hellkamp
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Richard C Becker
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | - Keith A A Fox
- University of Edinburgh and Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Graeme J Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, Australia
| | | | - Daniel E Singer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Manesh R Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Duke University Health System, Durham, NC, USA
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Duke University Health System, Durham, NC, USA
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, CA, USA
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Anguita M, de la Figuera M, Cabeza AIP, Fernández CS. Clinical profile and management of rivaroxaban in patients with atrial fibrillation in routine practice in Spain: data from six nationwide studies. Drugs Context 2019; 8:212606. [PMID: 31692949 PMCID: PMC6822684 DOI: 10.7573/dic.212606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 11/21/2022] Open
Abstract
AIMS To analyze the clinical profile and management of patients with nonvalvular atrial fibrillation taking rivaroxaban in routine practice in Spain. METHODS Clinical data from the observational studies HEROIC (cardiology and hematology; n=1,727), EMIR (cardiology; n=1,493), BRONCE-AP (primary care; n=133), SILVER-AP (primary care; n=457), ALADIN (internal medicine and neurology; n=249), and ESPARTA (internal medicine; n=110) of patients taking rivaroxaban were analyzed. The clinical profile was compared with those of the XANTUS and ROCKET-AF studies. RESULTS Overall, mean age was 74.9±9.4 years, CHA2DS2-VASc score was 3.7±1.5, and 43.2% had a HAS-BLED score ≥3. Patients included in the HEROIC and EMIR studies were older and more frequently had a creatinine clearance <50 mL/min and a higher thromboembolic risk than those in the XANTUS study, and patients included in the ALADIN study were older and had more prior cerebrovascular disease, but a lower thromboembolic risk than those in the ROCKET-AF trial. In those studies with available data, medication adherence and satisfaction with rivaroxaban were high. CONCLUSION Bearing in mind differences according to the clinical setting of each study, atrial fibrillation patients taking rivaroxaban in Spain were elderly and had a high thromboembolic risk. Medication adherence and satisfaction with rivaroxaban were high.
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Affiliation(s)
- Manuel Anguita
- Cardiology Department, Hospital Universitario Reina Sofia, Córdoba, Spain
| | | | | | - Carmen Suarez Fernández
- Internal Medicine Department, Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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Contreras Muruaga M, Reig G, Vivancos J, González A, Cardona P, Ramírez-Moreno J, Martí-Fábregas J, Suárez Fernández C, Pose A, Díaz JA, Rodríguez M, Pena M, Arias S, Larrosa D, González Á, Rodríguez E, González M, Fernández D, Barbagelata C, Raña N, Freire S, Cerqueiro JM, Guerrero H, Ramos L, Álvarez L, de Lis JM, Caro C, Seijo M, Mederer S, de Zarraga MA, Ferreiro J, Terrero JM, Arias M, Pérez R, Sánchez J, Maciñeiras J, Fernández J, Jaén F, Esteva D, Zamora M, Navarrete N, García J, Mérida L, Corrales MÁ, Quirós R, Cantero J, Barrero FJ, Villegas I, Castro J, Foronda J, Carrillo D, Vega J, Trujillo JA, Montero M, Jurado A, Sánchez C, Agüera-Morales E, Sánchez M, Durán P, Fernández de la Puerta R, Pérez de la Blanca M, Martínez MP, Fernández Ó, Tamayo JA, Bustamante R, Serrano PJ, Arjona A, Fernández J, Payan M, Gómez R, Peña D, Cabrerizo E, Salgado F, Ivanova Georgieva R, Gil-Núñez A, Bello E, Díaz F, Medina A, Castellano A, Miranda Y, Fabre Ó, García Polo I, Ibáñez P, Sainz C, Sierra F, Aragón E, Díaz J, Aguilar F, Ortega MÁ, Egido JA, Pontes JC, García MÁ, Cabrera F, Batalla B, Culla A, Molina C, Flores A, Seró L, Muchada M, Meler P, Boned-Riera S, Cánovas D, Estela J, Font J, Purroy F, Benabdelhak I, Sanahuja J, Roquer J, Rodríguez A, Ois Á, Cuadrado E, Jiménez J, Nogués X, Kuprinski J, German A, Irigoyen D, Cara JJ, Font MÀ, Huertas S, Martínez-Domeño A, Arroyo JA, Delgado-Mederos R, Gómez-Choco MJ, Mengual JJ, García SM, Castellanos MDM, van Eedenburg C, Cañas I, Espinosa J, Montull S, Quesada H, Ustrell X, Homedes C, Navalpotro I, Casanova J, Lago AP, Morata C, Gorriz D, Moreno I, Tembl J, Ponz A, Fonseca MJ, Chamarro R, Gil R, Oliver V, Pampliega A, Artero A, Puchades F, Landete L, Vilar C, Jiménez C, Vives B, Moragues MD, Díaz R, Tur S, Escribano JB, Lucas C, Martínez F, Pons JM, Romero A, García D, Pérez J, Villaverde R, Martínez S, Rodríguez A, Tejero C, Pérez C, Mostacero E, Fernández C, Luna A, Pérez T, González F, de Arce A, Martínez M, Díez N, Gállego J, Zandio B, Herrera M, Aymerich N, Muñoz R, Marta J, Artal J, Errea JM, Timiraos JJ, Moreno MP, Freijo M, García JM, Gil MC, Revilla MÁ, Palacio E, Vázquez JL, Bestué M, Latorre A, Calvo E, Ballester L, Serrano M, Juega JM, López MÁ, Irimia P, Imaz L, Fuentes B, Sanz BE, Beltrán L, Ruiz G, Martínez P, Sánchez D, Barroso E, Molina I, Budiño MA, Masjuan J, de Felipe A, Matute C, Tejada J, Morán A, Fernández E, Riveira MDC, Carnedo J, Manquillo A, González R, Fernández JC, Guillan M, Yebra M, Trejo JM, Saiz J, Martínez-Acitores JC, Bravo Y, Arenillas JF, Calleja A, Cortijo E, Reyes J, López L, Muñoz PL, Fidalgo MÁ, Hernández J, Gómez JC, Morán JC, Gonzalo S, Marrero J, Satué JÁ, Belinchón JC, Moniche F, Calderón E, Escudero I, de la Torre J, Casado I, Antón J, Portilla JC, Luengo J, Rosal J, Calzado E, Anglada JC, Girón J, Ramírez JM, Pijierro A, Roa A, Romero J, Aguayo M, Borrachero C, Sanz G, Gómez MJ, Rico MÁ, Cayon A, Carmona E, Cerro R, López R, Aguirre A, Lozano F, Rivera JM. Factors associated with poor anticoagulation control with vitamin K antagonists among outpatients attended in Internal Medicine and Neurology. The ALADIN study. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Comuth WJ, Lauridsen HH, Kristensen SD, Münster AMB. Translation, Cultural Adaptation, and Psychometric Properties of the Danish Version of the Anti-Clot Treatment Scale. TH OPEN 2018; 2:e280-e290. [PMID: 31249952 PMCID: PMC6524884 DOI: 10.1055/s-0038-1670631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/06/2018] [Indexed: 11/03/2022] Open
Abstract
Background
The Anti-Clot Treatment Scale (ACTS) is a 17-item, 2-factor (Burdens and Benefits), patient-reported outcome instrument to evaluate patient satisfaction with oral anticoagulant treatment.
Objectives
This study aimed to translate and culturally adapt the English version of the ACTS into Danish and to subsequently validate the Danish version in a population of patients treated with dabigatran etexilate for atrial fibrillation.
Methods
The ACTS was translated into Danish and culturally adapted. This prospective phase 4 study included 232 respondents who completed the Danish ACTS after 1 month of treatment with dabigatran etexilate for atrial fibrillation. Psychometric properties were evaluated. For test–retest reliability, the ACTS was measured twice, 2 weeks apart, in a subgroup of 50 stable patients.
Results
Generally, a high level of treatment satisfaction was found. Confirmatory factor analysis showed a suboptimal fit for the two-factor model of the original version. Using modification indices of confirmatory factor analysis, a four-factor model had the best fit. Cronbach's α for internal consistency was acceptable at 0.78. There was good test–retest reliability with intraclass correlation at 0.80. Smallest detectable changes (SDCs) for individual patients were 5.89 points for the total ACTS, 5.57 for the reverse Burdens, and 3.34 for Benefits scores. Group SDCs were 0.39, 0.37, and 0.22 respectively. Substantial ceiling effects limit the ability to detect improvement at the high end of the scale.
Conclusion
The Danish version of the ACTS has inadequate structural validity. Reliability was acceptable. Ceiling effects challenge detection of improvement of treatment satisfaction in clinical practice in this patient population.
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Affiliation(s)
- Willemijn J Comuth
- Department of Clinical Biochemistry, Regional Hospital of West Jutland, Herning, Denmark.,Department of Cardiology, Regional Hospital of West Jutland, Herning, Denmark.,Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henrik H Lauridsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Steen D Kristensen
- Faculty of Health, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anna-Marie B Münster
- Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark.,Department of Clinical Biochemistry, Hospital of South West Denmark, Esbjerg, Denmark
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Contreras Muruaga MM, Reig G, Vivancos J, González A, Cardona P, Ramírez-Moreno JM, Martí-Fábregas J, Suárez Fernández C. Factors associated with poor anticoagulation control with vitaminK antagonists among outpatients attended in Internal Medicine and Neurology. The ALADIN study. Rev Clin Esp 2018; 218:327-335. [PMID: 29983190 DOI: 10.1016/j.rce.2018.04.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/24/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To identify factors associated with poor anticoagulation control with vitaminK antagonists (VKA) among outpatients with nonvalvular atrial fibrillation (NVAF) attended in Neurology and Internal Medicine in Spain. METHODS Cross-sectional and multicenter study, from the ALADIN database, of outpatients with NVAF treated with VKA and attended in Internal Medicine and Neurology in Spain. Rates of anticoagulation control were determined with the direct and Rosendaal methods, considering data from the 6months before the inclusion. RESULTS Out of 1,337 patients included in the ALADIN study, 750 were taking VKA, and complete information about INR values in the last 6months was available in 383 patients. Mean scores of Charlson Index, CHADS2, CHA2DS2-VASc and HAS-BLED were 1.94±1.54; 3.10±1.26; 4.63±1.54, and 2.20±0.90, respectively. 46.2% and 47.0% of patients had an adequate anticoagulation control according to the direct and Rosendaal methods, respectively. Inadequate anticoagulation control according to the direct method was associated with diabetes (OR: 2.511; 95%CI: 1.144-5.659), prior labile INR (OR: 35.371; 95%CI: 15.058-83.083) and the determination of >6INR controls in the last 6months (OR: 4.747; 95%CI: 2.094-10.759), and according to the Rosendaal method, with prior labile INR (P<.001) and HAS-BLED score (OR: 3.991; 95%CI: 2.520-6.319). CONCLUSIONS Despite the high thromboembolic risk, only a little more than a half of patients were well controlled. Factors associated with poor anticoagulation control were diabetes, labile INR, >6INR controls and HAS-BLED.
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Affiliation(s)
- M M Contreras Muruaga
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España.
| | - G Reig
- Servicio de Neurología, Hospital Universitario de La Princesa, Madrid, España
| | - J Vivancos
- Servicio de Neurología, Hospital Universitario de La Princesa, Madrid, España
| | - A González
- Servicio de Neurología y Neurofisiología Clínica, Hospital San Roque Las Palmas, Las Palmas, España
| | - P Cardona
- Servicio de Neurología, Hospital Universitario de Bellvitge (HUB), Hospitalet de Llobregat, Barcelona, España
| | - J M Ramírez-Moreno
- Unidad de Ictus, Servicio de Neurología, Departamento de Ciencias Biomédicas, Hospital Universitario Infanta Cristina, Badajoz, España
| | - J Martí-Fábregas
- Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, España
| | - C Suárez Fernández
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España
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10
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Diferencias en el manejo de los pacientes con fibrilación auricular según inicie el tratamiento con anticoagulantes orales de acción directa el médico de atención primaria o el especialista. Estudios SILVER-AP y BRONCE-AP. Semergen 2018; 44:323-334. [DOI: 10.1016/j.semerg.2017.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/23/2017] [Accepted: 09/12/2017] [Indexed: 12/31/2022]
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de la Figuera M, Cinza S, Egocheaga I, Marín N, Prieto MA. Clinical characteristics and management of patients with atrial fibrillation treated with direct oral anticoagulants according to blood pressure control. HIPERTENSION Y RIESGO VASCULAR 2018; 35:e1-e9. [PMID: 29454558 DOI: 10.1016/j.hipert.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the clinical characteristics and management of hypertensive patients with nonvalvular atrial fibrillation (AF) treated with direct oral anticoagulants (DOACs) according to blood pressure (BP) control. METHODS For this purpose, data from two observational, cross-sectional and multicenter studies were combined. In both studies, patients on chronic treatment with anticoagulants and that were on current treatment with DOACs at least for 3 months were included. Adequate BP was defined as a systolic BP<140mmHg and a diastolic BP<90mmHg (<140/85mmHg if diabetes). RESULTS Overall, 1036 patients were included. Of these, 881 (85%) had hypertension that were finally analyzed. The presence of other risk factors and cardiovascular disease was common. Mean BP was 132.6±14.3/75.2±9.2mmHg and 70.5% of patients achieved BP goals. Those patients with a poor BP control had more frequently diabetes, and a history of prior labile INR. Patients had a high thromboembolic risk, but without significant differences according to BP control. By contrast, more patients with a poor BP control had a higher bleeding risk (HAS-BLED ≥3: 24.0% vs 35.4%; P<0.001). HAS-BLED score was an independent predictor of poor BP control (odds ratio 1.435; 95% confidence interval 1.216-1.693; P<0.001). Satisfaction with anticoagulant treatment was independent of BP control. CONCLUSIONS More than two thirds of our patients with hypertension and AF anticoagulated with DOACs achieve BP targets, what is clearly superior to that reported in the general hypertensive population.
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Affiliation(s)
| | - S Cinza
- CS Porto do Son, Santiago de Compostela, Spain
| | | | - N Marín
- Bayer Hispania S.L., General Medicine CV, Barcelona, Spain.
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12
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Suárez Fernández C, Castilla-Guerra L, Cantero Hinojosa J, Suriñach JM, Acosta de Bilbao F, Tamarit JJ, Diaz Diaz JL, Hernandez JL, Pose A, Montero-Pérez-Barquero M, Roquer J, Gállego J, Vivancos J, Mostaza JM. Satisfaction with oral anticoagulants in patients with atrial fibrillation. Patient Prefer Adherence 2018; 12:267-274. [PMID: 29497282 PMCID: PMC5822854 DOI: 10.2147/ppa.s152109] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Although, by itself, atrial fibrillation is associated with an impairment of quality of life antithrombotic therapy may play a role. OBJECTIVE To evaluate the satisfaction with anticoagulant treatment in patients with nonvalvular atrial fibrillation who attended internal medicine departments in Spain. METHODS Patients from two different cross-sectional studies were combined. To measure the satisfaction with anticoagulant treatment, the Anti-Clot-Treatment Scale (ACTS) questionnaire was completed by every patient. A multivariate analysis was performed to determine the variables associated with satisfaction of patients receiving oral anticoagulants. RESULTS A total of 1,309 patients (mean age 78.5±8.4 years; 49.3% men; CHA2DS2VASC 4.9±1.5; HAS-BLED 2.0±0.9) were included in the study, of whom 902 (68.9%) were taking vitamin K antagonists (VKA) and 407 (31.1%) direct oral anticoagulants (DOACs). Overall, satisfaction with oral anticoagulation was high (ACTS Burdens scale 49.69±9.45; ACTS Benefits scale 11.35±2.61). The perceived burdens with anticoagulant treatment were lower in men, as well as in patients with no dependency, normal renal function, who were not polymedicated, or who had moderate bleeding risk. Among patients taking VKA, those subjects with a lower number of International Normalized Ratio (INR) determinations in the last 6 months or with an optimal time in the therapeutic range exhibited a lower perceived burden. Patients taking DOACs (vs VKA) showed a lower perceived burden with anticoagulation. Benefits with anti-coagulation were higher in men, younger patients, those with no dependency, or low bleeding risk. Perceived benefits were higher in patients taking DOACs (vs VKA). CONCLUSION Satisfaction with oral anticoagulation was high in patients with nonvalvular atrial fibrillation, who were attending internal medicine departments daily in Spain. Among patients taking VKA, those subjects with a lower number of INR determinations in the last 6 months or with an optimal time in the therapeutic range exhibited a lower perceived burden with anticoagulant therapy. Patients taking DOACs (vs VKA) showed lower perceived burdens and higher perceived benefits with anticoagulation.
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Affiliation(s)
| | | | | | | | - Fernando Acosta de Bilbao
- Internal Medicine Service, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria
| | | | - José Luis Diaz Diaz
- Internal Medicine Service, Complejo Universitario Hospitalario de A Coruña, La Coruña
| | - Jose Luis Hernandez
- Internal Medicine Service, Hospital Marqués de Valdecilla, Universidad de Cantabria, Santander
| | - Antonio Pose
- Internal Medicine Service, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela
| | - Manuel Montero-Pérez-Barquero
- Internal Medicine Service, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Reina Sofía, Universidad de Córdoba, Córdoba
| | | | - Jaime Gállego
- Neurology Service, Complejo Hospitalario de Navarra, Pamplona, Navarra
| | - José Vivancos
- Neurology Service, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria La Princesa, Madrid
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13
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de la Figuera M, Cinza S, Marín N, Egocheaga I, Prieto MA. [Clinical characteristics of patients with atrial fibrillation treated with direct oral anticoagulants attended in primary care setting. The SILVER-AP study]. Aten Primaria 2017; 50:359-367. [PMID: 28764897 PMCID: PMC6839200 DOI: 10.1016/j.aprim.2017.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/30/2017] [Indexed: 01/06/2023] Open
Abstract
Objetivo Describir las características clínicas y el manejo de pacientes con fibrilación auricular no valvular (FANV) tratados con anticoagulantes orales de acción directa (ACOD). Diseño Estudio observacional, transversal y multicéntrico. Emplazamiento Comunidades autónomas en las que el médico de atención primaria puede prescribir ACOD (n = 9). Participantes Un total de 790 pacientes con riesgo de ictus o embolia sistémica que estuviesen en tratamiento crónico con anticoagulantes, que hubiesen modificado su pauta terapéutica, y que actualmente estuviesen en tratamiento con un ACOD durante al menos 3 meses. Mediciones principales Recogida de datos sociodemográficos y de manejo clínico. Resultados La edad media de los sujetos fue de 78,6 ± 8,4 años; un 50,5% eran varones; CHADS2: 2,6 ± 1,2; CHA2DS2-VASc: 4,3 ± 1,6; HAS-BLED: 2,3 ± 1,0. La duración media del tratamiento con ACOD fue de 15,8 ± 12,5 meses. El ACOD más frecuentemente prescrito fue rivaroxabán (57,8%), seguido de dabigatrán (23,7%) y apixabán (18,5%). De los pacientes que tomaban rivaroxabán, el 70,2% recibieron la dosis de 20 mg/día. En el caso de dabigatrán, el 41,7% tomaban la dosis de 150 mg/12 h, y con respecto a apixabán, el 56,2% tomaban la dosis de 5 mg/12 h. La satisfacción con el tratamiento con ACOD (cuestionario ACTS: 52,0 ± 7,2 puntos en la escala Carga y 12,1 ± 2,2 puntos en la escala Beneficio) y el cumplimiento (97,8% de los pacientes fueron cumplidores) fueron elevados. Conclusiones Los pacientes en tratamiento con ACOD en España tienen un elevado riesgo tromboembólico. Una proporción significativa de sujetos reciben una dosis menor de ACOD de la que les correspondería por sus características clínicas. La satisfacción y la adherencia son elevadas.
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Affiliation(s)
| | - Sergio Cinza
- Centro de Saúde (CS) Porto do Son, Santiago de Compostela, España
| | - Nuria Marín
- Bayer Hispania S.L., General Medicine CV, Barcelona, España.
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Contreras Muruaga MDM, Vivancos J, Reig G, González A, Cardona P, Ramírez-Moreno JM, Martí J, Suárez Fernández C. Satisfaction, quality of life and perception of patients regarding burdens and benefits of vitamin K antagonists compared with direct oral anticoagulants in patients with nonvalvular atrial fibrillation. J Comp Eff Res 2017; 6:303-312. [PMID: 28353372 DOI: 10.2217/cer-2016-0078] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIM To compare the satisfaction of patients treated with vitamin K antagonists (VKA) with that of patients treated with direct oral anticoagulants (DOACs) and to determine the impact on quality of life of both treatments in patients with nonvalvular atrial fibrillation (NVAF). METHODS Cross-sectional multicenter study in which outpatients with NVAF completed the ACTS (Anti-Clot Treatment Scale), SAT-Q (Satisfaction Questionnaire) and EQ-5D-3L (EuroQol 5 dimensions questionnaire, 3 level version) questionnaires. RESULTS The study population comprised 1337 patients, of whom 587 were taking DOACs and 750 VKAs. Compared with VKAs, DOACs were more commonly prescribed in patients with a history of stroke and in patients with a higher thromboembolic risk. The study scores were as follows: SAT-Q: 63.8 ± 17.8; EQ-5D-3L total score: 75.6 ± 20.9; visual analog scale: 63.1 ± 20.6; ACTS Burdens: 51.8 ± 8.4 and ACTS Benefits: 11.9 ± 2.4. The ACTS Burdens score and ACTS Benefits score were higher with DOACs than with VKAs (54.83 ± 6.11 vs 49.50 ± 9.15; p < 0.001 and 12.36 ± 2.34 vs 11.48 ± 2.46; p < 0.001 respectively). CONCLUSION NVAF patients treated with oral anticoagulants had many comorbidities and a high thromboembolic risk. Satisfaction and quality of life with oral anticoagulants were high, although they were both better with DOACs than with VKAs.
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Affiliation(s)
| | - José Vivancos
- Servicio de Neurología, Hospital Universitario de La Princesa, Madrid, Spain
| | - Gemma Reig
- Servicio de Neurología, Hospital Universitario de La Princesa, Madrid, Spain
| | - Ayoze González
- Servicio de Neurología y Neurofisiología Clínica, Hospital San Roque Las Palmas, Las Palmas, Spain
| | - Pere Cardona
- Servicio de Neurología, Hospital Universitario de Bellvitge (HUB), Barcelona, Spain
| | - José Mª Ramírez-Moreno
- Unidad de Ictus. Servicio de Neurología. Departamento de Ciencias Biomédicas. Hospital Universitario Infanta Cristina, Madrid, Spain
| | - Joan Martí
- Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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