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Wilson RE, Burton L, Marini N, Loewen P, Janke R, Aujla N, Davis D, Rush KL. Assessing the impact of atrial fibrillation self-care interventions: A systematic review. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 43:100404. [PMID: 38831787 PMCID: PMC11144727 DOI: 10.1016/j.ahjo.2024.100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 06/05/2024]
Abstract
This systematic review evaluates the efficacy of self-care interventions for atrial fibrillation (AF), focusing on strategies for maintenance, monitoring, and management applied individually or in combination. Adhering to the 2020 PRISMA guidelines, the search strategy spanned literature from 2005 to 2023, utilizing keywords and subject headings for "atrial fibrillation" and "self-care" combined with the Boolean operator AND. The databases searched included Medline, Embase, and CINAHL. The initial search, conducted on February 17, 2021, and updated on May 16, 2023, identified 5160 articles, from which 2864 unique titles and abstracts were screened. After abstract screening, 163 articles were reviewed in full text, resulting in 27 articles being selected for data extraction; these studies comprised both observational and randomized controlled trial designs. A key finding in our analysis reveals that self-care interventions, whether singular, dual, or integrated across all three components, resulted in significant improvements across patient-reported, clinical, and healthcare utilization outcomes compared to usual care. Educational interventions, often supported by in-person sessions or telephone follow-ups, emerged as a crucial element of effective AF self-care. Additionally, the integration of mobile and web-based technologies alongside personalized education showed promise in enhancing outcomes, although their full potential remains underexplored. This review highlights the importance of incorporating comprehensive, theory-informed self-care interventions into routine clinical practice and underscores the need for ongoing innovation and the implementation of evidence-based strategies. The integration of education and technology in AF self-care aligns with the recommendations of leading health organizations, advocating for patient-centered, technology-enhanced approaches to meet the evolving needs of the AF population.
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Affiliation(s)
- Ryan E. Wilson
- School of Nursing, The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Lindsay Burton
- School of Nursing, The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Noah Marini
- School of Nursing, The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Peter Loewen
- School of Nursing, The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Robert Janke
- School of Nursing, The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Noorat Aujla
- School of Nursing, The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Dresya Davis
- School of Nursing, The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Kathy L. Rush
- School of Nursing, The University of British Columbia Okanagan, Kelowna, BC, Canada
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Rekk K, Arnet I, Dietrich F, Polymeris AA, Lyrer PA, Engelter ST, Schaedelin S, Allemann SS. Relationship between electronically monitored adherence to direct oral anticoagulants and ischemic or hemorrhagic events after an initial ischemic stroke-A case control study. PLoS One 2024; 19:e0301421. [PMID: 38662779 PMCID: PMC11045050 DOI: 10.1371/journal.pone.0301421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/15/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Patients with atrial fibrillation (AF) have a high risk for recurrent clinical events after an ischemic stroke. Direct oral anticoagulants (DOAC) are prescribed for secondary prevention. Adherence to DOAC is crucial mainly because of their short elimination half-life. Non-adherence to DOAC can negatively impact patients' outcomes. The relationship between (non-)adherence and recurrent clinical events is unknown in AF patients after initial stroke. We investigated adherence to DOAC in stroke survivors with AF who were included in the MAAESTRO study at the University Hospital Basel, Switzerland, between 2008 and 2022. METHODS This study is a secondary analysis of data from MAAESTRO with a matched nested case-control design and 1:2 ratio. DOAC intake was measured with a small electronic device (Time4MedTM). We defined two arbitrary intervals of 17 days and 95 days as the longest time spans with electronic monitoring data per patient to maximize the number of participants with adequate amount of observation time available for analysis. Taking and timing adherence were calculated retrospectively i.e., prior to the recurrent event for cases. Trendline analysis of adherence over 95 days was calculated. Linear regression analysis was performed after adjusting for the co-variables age and daily pill burden. Sensitivity analysis was performed with controls for intervals in the reverse direction (prospectively). RESULTS We analyzed 11 cases and 22 matched controls (mean age: 75.9 ± 9.2 years vs. 73.1 ± 8.4 years; n.s.) with similar stroke characteristics (NIHSS, mRS, MoCA) and 36.4% women in each group. Mean adherence values were high and similar between cases and controls (95 days taking: 87.0 ± 18.9% (cases) vs. 90.8 ± 9.8% (controls), n.s.; similar values for timing adherence). Six hemorrhagic and five ischemic events had occurred. Compared to controls, a significantly higher 95 days taking adherence was observed for hemorrhagic events (96.0 ± 5.0% (cases) vs. 88.1 ± 11.5% (controls); p<0.01) and a significantly lower 95 days taking adherence was observed for ischemic events (75.7 ± 24.8% (cases) vs. 94.2 ± 6.2% (controls), p = 0.024). Values for timing adherence were similar. A non-significant downward linear trend of adherence was observed over 95 days independently of the clinical events. The sensitivity analysis showed that the direction of the interval had negligible impact on the 95 days adherence. CONCLUSION Because recurrent ischemic events after an AF-related stroke were associated with low adherence to DOAC <76%, adherence enhancing interventions seem crucial in anticoagulated AF-patients. However, AF-patients with high adherence might benefit from a regular re-assessment of the bleeding risk as hemorrhagic complications were associated with adherence to DOAC >96%. TRIAL REGISTRATION ClinicalTrials.gov NCT03344146.
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Affiliation(s)
- Katharina Rekk
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | - Isabelle Arnet
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | - Fine Dietrich
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
| | - Alexandros A. Polymeris
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Philippe A. Lyrer
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stefan T. Engelter
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Geriatric Medicine, Neurology and Neurorehabilitation, Felix Platter Hospital, University of Basel, Basel, Switzerland
| | - Sabine Schaedelin
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Samuel S. Allemann
- Department of Pharmaceutical Sciences, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland
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Kengne AP, Brière JB, Gudiña IA, Jiang X, Kodjamanova P, Bennetts L, Khan ZM. The impact of non-pharmacological interventions on adherence to medication and persistence in dyslipidaemia and hypertension: a systematic review. Expert Rev Pharmacoecon Outcomes Res 2024:1-10. [PMID: 38366854 DOI: 10.1080/14737167.2024.2319598] [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: 07/19/2023] [Accepted: 02/13/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Suboptimal medication adherence is common among patients with cardiovascular diseases. We sought evidence on non-pharmacological interventions used to support adherence for patients with hypertension and/or dyslipidemia. METHODS We searched MEDLINE, EMBASE, MEDLINE In-Process, ClinicalTrials.gov, EUCTR, and conference proceedings from July 2011 to July 2021 to identify trials evaluating effects of health education, phone reminders, or digital interventions on medication adherence or persistence of adult patients with hypertension and/or dyslipidemia. Risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool v2. RESULTS Of 64 studies, 62 used health education approaches (e.g. educational interviews, motivational meetings, advice from physicians, and mobile health content), 16 phone reminders (e.g. text reminders, electronic pill-box linked reminders, bi-directional text messaging), and 10 digital applications as interventions (e.g., various self-management applications). All studies assessed medication adherence; only two persistence. Overall, 30 studies (83%) assessing health education approaches alone and 25 (78%) combined with other strategies, 12 (75%) phone reminders and eight studies (80%) digital applications combined with other strategies reported improved medication adherence. Two studies assessing health education approaches reported improved persistence. CONCLUSIONS Our findings indicate non-pharmacological interventions may positively impact adherence. Therefore, 'beyond the pill' approaches could play a role in preventing cardiovascular diseases.
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Affiliation(s)
| | | | | | - Xiaobin Jiang
- Health Economics and Market Access, Amaris Consulting, Shanghai, China
| | - Petya Kodjamanova
- Health Economics and Market Access, Amaris Consulting, Sofia, Bulgaria
| | - Liga Bennetts
- Health Economics and Market Access, Amaris Consulting, Montréal, Canada
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Dietrich F, Polymeris AA, Albert V, Engelter ST, Hersberger KE, Schaedelin S, Lyrer PA, Arnet I. Intake reminders are effective in enhancing adherence to direct oral anticoagulants in stroke patients: a randomised cross-over trial (MAAESTRO study). J Neurol 2024; 271:841-851. [PMID: 37831125 PMCID: PMC10827905 DOI: 10.1007/s00415-023-12035-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Direct oral anticoagulants (DOAC) effectively prevent recurrent ischaemic events in atrial fibrillation (AF) patients with recent stroke. However, excellent adherence to DOAC is mandatory to guarantee sufficient anticoagulation as the effect quickly subsides. AIM To investigate the effect of intake reminders on adherence to DOAC. METHODS MAAESTRO was a randomised, cross-over study in DOAC-treated AF patients hospitalised for ischaemic stroke. Adherence was measured by electronic monitoring for 12 months. After an observational phase, patients were randomised to obtain an intake reminder either in the first or the second half of the subsequent 6-month interventional phase. The primary outcome was 100%-timing adherence. Secondary outcomes were 100%-taking adherence, and overall timing and taking adherence. We analysed adherence outcomes using McNemar's test or mixed-effects logistic models. RESULTS Between January 2018 and March 2022, 130 stroke patients were included, of whom 42 dropped out before randomisation. Analysis was performed with 84 patients (mean age: 76.5 years, 39.3% women). A 100%-timing adherence was observed in 10 patients who were using the reminder, and in zero patients without reminder (p = 0.002). The reminder significantly improved adherence to DOAC, with study participants having 2.7-fold increased odds to achieve an alternative threshold of 90%-timing adherence (OR 2.65; 95% CI 1.05-6.69; p = 0.039). A similar effect was observed for 90%-taking adherence (OR 3.06; 95% CI 1.20-7.80; p = 0.019). Overall timing and taking adherence increased significantly when using the reminder (OR 1.70; 95% CI 1.55-1.86, p < 0.01; and OR 1.67; 95% CI 1.52-1.84; p < 0.01). CONCLUSION Intake reminders increased adherence to DOAC in patients with stroke attributable to atrial fibrillation. TRIAL REGISTRATION ClinicalTrials.gov: NCT03344146.
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Affiliation(s)
- Fine Dietrich
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, 4056, Basel, Switzerland.
| | - Alexandros A Polymeris
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Petersgraben 4, 4051, Basel, Switzerland
| | - Valerie Albert
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, 4056, Basel, Switzerland
| | - Stefan T Engelter
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Petersgraben 4, 4051, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine Felix Platter, University of Basel, Burgfelderstrasse 101, 4055, Basel, Switzerland
| | - Kurt E Hersberger
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, 4056, Basel, Switzerland
| | - Sabine Schaedelin
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel and University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
| | - Philippe A Lyrer
- Department of Neurology and Stroke Centre, University Hospital Basel and University of Basel, Petersgraben 4, 4051, Basel, Switzerland
| | - Isabelle Arnet
- Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Klingelbergstrasse 50, 4056, Basel, Switzerland
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Cao Y, Feng YY, Du W, Li J, Fei YL, Yang H, Wang M, Li SJ, Li XJ, Han B. Non‑persistence to Oral Anticoagulation Therapy in Elderly Patients with Non‑valvular Atrial Fibrillation. Patient Prefer Adherence 2023; 17:3185-3194. [PMID: 38084322 PMCID: PMC10710792 DOI: 10.2147/ppa.s435592] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/25/2023] [Indexed: 03/22/2024] Open
Abstract
PURPOSE To investigate the reasons for elderly atrial fibrillation (AF) patients not continuing their oral anticoagulation (OAC) treatment and the factors that influence this behavior. METHODS Elderly AF patients (aged≥75 years) hospitalized from December 2019 to May 2022 were consecutively enrolled. Clinical, demographic, and concomitant medication data were collected. The endpoint was defined as OAC discontinuation for more than 30 days or a switch to an alternative therapy. Predictors of OAC non-persistence were investigated using a multivariable Cox regression model. RESULTS This study included 560 participants (51.1% men, mean age 80.9±0.2 years). During a median follow-up of 20 months, medication persistence was observed in 322 patients (57.5%). Non-persistence was found to be significantly higher with warfarin than with NOAC (48.8% vs 33.6%, p = 0.006). In the multivariate analysis, OAC non-persistence was independently predicted by a history of permanent pacemaker implantation, the use of antiplatelet drugs, employee Medicare, living with children, college degree or above, and persistent AF (HR = 1.580, 1.586, 0.604, 0.668, 0.028, 0.769, p < 0.05, respectively). Treatment discontinuation within 3 months of discharge was observed in a large number of patients (81.8%). Medication discontinuation due to bleeding was more frequently observed in patients who continued for longer than 3 months (p < 0.001), while discontinuation due to patient preference was more frequent in those with shorter durations (≤3 months) (p = 0.049). Patient preference was the second leading cause of non-persistence in patients, regardless of whether they were taking warfarin or NOAC. CONCLUSION OAC non-persistence remains high among elderly AF patients during long-term follow-up, with a significant proportion discontinuing shortly after discharge. This pattern of non-persistence is heavily influenced by demographic factors and patient preference. Further interventions should be developed based on the reasons and risk factors to improve persistence and initiated early in the treatment process.
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Affiliation(s)
- Yue Cao
- Division of Cardiology, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
| | - Yue-Yue Feng
- Division of Cardiology, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
| | - Wei Du
- Division of Cardiology, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
| | - Jing Li
- Division of Cardiology, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
| | - Ya-Lan Fei
- Division of Cardiology, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
| | - Hao Yang
- Division of Cardiology, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
| | - Meng Wang
- Division of Cardiology, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
| | - Shi-Jie Li
- Division of Cardiology, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
| | - Xian-Jin Li
- Division of Cardiology, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
| | - Bing Han
- Division of Cardiology, Xuzhou Central Hospital, Xuzhou, People’s Republic of China
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van der Horst SFB, de Vries TA, Chu G, Bavalia R, Xiong H, van de Wiel KM, Mulder K, van Ballegooijen H, de Groot JR, Middeldorp S, Klok FA, Hemels ME, Huisman MV. Prevalence and Predictors of Nonadherence to Direct Oral Anticoagulant Treatment in Patients with Atrial Fibrillation. TH OPEN 2023; 7:e270-e279. [PMID: 37772087 PMCID: PMC10533218 DOI: 10.1055/a-2161-0928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/25/2023] [Indexed: 09/30/2023] Open
Abstract
Background For most patients with newly diagnosed atrial fibrillation (AF), direct oral anticoagulants (DOACs) are preferred over vitamin K antagonists. However, there is concern that the lack of monitoring may impair therapy adherence and therefore the anticoagulant effect. Objective To assess 1-year DOAC nonadherence in patients with AF and a treatment indication of at least 1 year in the Dutch health care setting, and to identify predictors of nonadherence. Methods We performed a near-nationwide historical cohort study in patients with a novel DOAC indication for AF. Data were obtained from a pharmacy database, covering 65% of all outpatient prescriptions dispensed in the Netherlands. The 1-year nonadherence was assessed by the proportion of days covered; the threshold was set at <80%. Robust Poisson regression analyses were performed to identify predictors of nonadherence. Results A total of 46,211 patients were included and the 1-year nonadherence was 6.5%. We identified male sex (risk ratio [RR] 1.23, 95% confidence interval [CI]: 1.15-1.33), younger age (age ≥60 to <70 years: RR: 1.15, 95% CI: 1.00-1.33, age <60 years: RR: 2.22, 95% CI: 1.92-2.57; reference age ≥85 years), a reduced DOAC dose (RR: 1.10, 95% CI: 1.00-1.22), a twice-daily dosing regimen (RR: 1.21, 95% CI: 1.12-1.30), and treatment with apixaban (RR: 1.16, 95% CI: 1.06-1.26, reference rivaroxaban) or dabigatran (RR: 1.25, 95% CI: 1.14-1.37) as independent predictors of 1-year nonadherence. Conclusion One-year nonadherence to DOACs was low yet relevant in patients with AF newly prescribed a DOAC. Understanding the predictors for nonadherence may help identify patients at risk.
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Affiliation(s)
| | - Tim A.C. de Vries
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Heart Center, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
- Department of Cardiology, Hospital Rijnstate, Arnhem, The Netherlands
| | - Gordon Chu
- Department of Thrombosis and Hemostasis, Leiden UMC, Leiden, The Netherlands
- Department of Internal Medicine, Alrijne Hospital, Leiden, The Netherlands
| | - Roisin Bavalia
- Department of Vascular Medicine, Amsterdam UMC location University of Amsterdam, The Netherlands
- GGD Amsterdam, Amsterdam, The Netherlands
| | - Helen Xiong
- IQVIA Netherlands, Amsterdam, The Netherlands
| | | | | | | | - Joris R. de Groot
- Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Heart Center, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Frederikus A. Klok
- Department of Thrombosis and Hemostasis, Leiden UMC, Leiden, The Netherlands
| | - Martin E.W. Hemels
- Department of Cardiology, Hospital Rijnstate, Arnhem, The Netherlands
- Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
| | - Menno V. Huisman
- Department of Thrombosis and Hemostasis, Leiden UMC, Leiden, The Netherlands
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Impact of the COVID-19 lockdown on the adherence of stroke patients to direct oral anticoagulants: a secondary analysis from the MAAESTRO study. J Neurol 2022; 269:19-25. [PMID: 34081196 PMCID: PMC8173508 DOI: 10.1007/s00415-021-10631-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The negative impact of the COVID-19 outbreak on stroke care has been reported, but no data exist on the influence of the lockdown on medication adherence to antithrombotic treatment for stroke prevention. We present a comparison of electronic adherence data of stroke patients treated with direct oral anticoagulants (DOAC) prior to and during the COVID-19 lockdown in spring 2020 in Switzerland. METHODS This is a secondary analysis using data from the ongoing MAAESTRO study, in which stroke patients with atrial fibrillation electronically monitor their adherence to DOAC treatment. Eligible patients for this analysis had at least four weeks of adherence data prior to and during the COVID-19 lockdown. Three adherence metrics (taking adherence, timing adherence, drug holidays) were calculated and compared descriptively. RESULTS The analysis included eight patients (median age 81.5 years, IQR 74.8-84.5). Five patients had a pre-lockdown taking adherence over 90% (mean 96.8% ± 2.9), with no change during lockdown, high timing adherence in both periods and no drug holidays. The remaining three patients had pre-lockdown taking and timing adherence below 90%. Of those, two patients showed a moderate decline either in taking or timing adherence compared to pre-lockdown. One showed a substantial increase in taking and timing adherence during lockdown (both + 25.8%). CONCLUSION Our data suggest that a major disruption of social life (i.e., the imposed COVID-19 lockdown) is unlikely to relevantly affect the medication intake behaviour of patients with high pre-established adherence, but might have an impact in patients with previously suboptimal adherence. TRIAL REGISTRATION NUMBER MAAESTRO: electronic Monitoring and improvement of Adherence to direct oral Anticoagulant treatment-a randomized crossover study of an Educational and reminder-based intervention in ischaemic STROke patients under polypharmacy, NCT03344146.
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Valery JR, Marar A, Pujalte G, Ward C, Abdelmoneim YM, Fitzgerald PJ, Mwakyanjala E, Harris DM, Murray L, Heckman MG, White LJ, Stancampiano F. Assessment of Knowledge Regarding Risks and Benefits of the Use of Non-Vitamin K Antagonist Oral Anticoagulants. J Prim Care Community Health 2022; 13:21501319221118806. [PMID: 36000450 PMCID: PMC9424872 DOI: 10.1177/21501319221118806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Non-vitamin K antagonist oral anticoagulants (NOAC) have replaced vitamin K antagonist (VKA) oral anticoagulants as the first-line treatment option for stroke prevention in high-risk patients with atrial fibrillation. With VKA therapy, disease and treatment-related knowledge is associated with improved adherence and outcomes. There is concern that due to the lack of need for ongoing visits for laboratory monitoring in patients on NOACs, there is less opportunity for education, leading to poor disease- and treatment-related knowledge in this patient group. METHODS One hundred ninety-nine (199) patients presenting to 2 primary care clinics on NOAC therapy were surveyed regarding atrial fibrillation and their knowledge regarding NOACs. Chart review was completed to determine patient characteristics and data obtained was compared with survey results to determine the accuracy of the survey responses. RESULTS Patients with a lower degree of NOAC knowledge tended to be older (P < .001), have higher Charlson Comorbidity Index scores (P = .001), use apixaban more often (P = .008), and have been on NOACs for a shorter time period (P = .007). CONCLUSIONS There is an opportunity to improve NOAC-related knowledge in patients with atrial fibrillation. When developing educational interventions, patient characteristics associated with poor knowledge should be considered. Based on our results, these are patients who are older, more medically complex, are on apixaban, and have been on NOAC therapy for a shorter duration.
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Affiliation(s)
- Jose Raul Valery
- Division of Community Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Ahmad Marar
- University of Florida College of Pharmacy, Gainesville, FL, USA
| | - George Pujalte
- Division of Family Medicine, and Orthopedics, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Cynthia Ward
- Primary Care Pharmacy, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Yousif M Abdelmoneim
- Division of Laboratory Medicine and Pathology Mayo Clinic Florida, Jacksonville, FL, USA
| | - Patrick J Fitzgerald
- Division of Community Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Edson Mwakyanjala
- Division of Community Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Dana M Harris
- Division of Community Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Loren Murray
- Division of Community Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Michael G Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Launia J White
- Division of Clinical Trials and Biostatistics, Mayo Clinic Florida, Jacksonville, FL, USA
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9
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Senoo K, Miki T, Ohkura T, Iwakoshi H, Nishimura T, Shiraishi H, Teramukai S, Matoba S. Smartphone Application to Improve Oral Anticoagulation Adherence in Patients with Atrial Fibrillation: Prospective Observational Study. JMIR Mhealth Uhealth 2021; 10:e30807. [PMID: 34894626 PMCID: PMC8783280 DOI: 10.2196/30807] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 11/25/2021] [Accepted: 12/07/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Poor adherence to oral anticoagulants (OACs) in elderly patients with atrial fibrillation (AF) has been shown to negatively impact healthcare costs, morbidity, and mortality. Although various methods such as automated reminders, counseling, telephone support, and patient education have been effective in improving medication adherence, the burden on healthcare providers has been considerable. Recently, an attempt has been made to improve medication adherence without burdening healthcare providers by using smartphone applications (i.e., app), but the use of the app for elderly patients with AF is still limited. OBJECTIVE The purpose of this study was to determine whether the new-developed smartphone application for AF patients (The Smart AF app) that integrates education, automatic reminder and patient engagement strategies with a simple user interface (UI) can improve medication adherence in elderly patients with AF. METHODS Patient enrollment was done by obtaining informed consent from AF patients attending Kyoto Prefectural University of Medicine hospitals between May 2019 and September 2020. Follow-up was planned at 1, 3, and 6 months after enrollment, and questionnaire reminders were automatically sent to patient applications at designated follow-up time points. A questionnaire-based survey of medication adherence was performed electronically using the self-reported 8-item Morisky Medication Adherence Scale (MMAS-8) as the survey tool. RESULTS A total of 136 patients with AF were enrolled in this study. During the follow-up period, 112 patients underwent follow-up at 1 month, 107 at 3 months, and 96 at 6 months. The mean age of the enrolled patients was 64.3 years, and males accounted for 79.4% (108/136) of the study population. The mean CHADS2 score was 1.2, with hypertension being the most common comorbidity. At the time of enrollment, 126 and 10 patients were taking direct oral anticoagulants (DOACs) and warfarin, respectively. For medication adherence as measured according to the MMAS-8, MMAS scores at 1 month, 3 months, and 6 months were significantly improved compared with baseline MMAS scores. (all p values<0.01). The overall improvement in medication adherence achieved by the 6-month intervention was as follows. 77.8% (14/18) of patients in the high adherence group (score=8) at baseline remained, 45.3% (24/53) of patients in the medium adherence group (score=6 to <8) at baseline moved to the high adherence group, and 72% (18/25) of patients in the low adherence group (score<6) moved to either the medium or high adherence group. CONCLUSIONS The Smart AF app improved medication adherence among elderly patients with AF. In the realm of medication management, an approach using mobile health technology that emphasizes education, automatic reminder and patient engagement, may be helpful.
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Affiliation(s)
- Keitaro Senoo
- Department of Cardiac Arrhythmia Research and Innovation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-shi, Kamigyo-ku Kajii-cho 465, Kawaramachi-Hirokoji, Kyoto, JP.,Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JP
| | - Tomonori Miki
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JP
| | - Takashi Ohkura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JP
| | - Hibiki Iwakoshi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JP
| | - Tetsuro Nishimura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JP
| | - Hirokazu Shiraishi
- Department of Cardiac Arrhythmia Research and Innovation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-shi, Kamigyo-ku Kajii-cho 465, Kawaramachi-Hirokoji, Kyoto, JP.,Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JP
| | - Satoshi Teramukai
- Departments of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JP
| | - Satoaki Matoba
- Department of Cardiac Arrhythmia Research and Innovation, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto-shi, Kamigyo-ku Kajii-cho 465, Kawaramachi-Hirokoji, Kyoto, JP.,Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JP
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10
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Abstract
The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world’s population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them. Since publication of the AF Roadmap in 2017, there have been many technological advances including devices and artificial intelligence for identification and prediction of unknown AF, better methods to achieve rhythm control, and widespread uptake of smartphones and apps that could facilitate new approaches to healthcare delivery and increasing community AF awareness. In addition, the World Health Organisation added the non-vitamin K antagonist oral anticoagulants (NOACs) to the Essential Medicines List, making it possible to increase advocacy for their widespread adoption as therapy to prevent stroke. These advances motivated the WHF to commission a 2020 AF Roadmap update. Three years after the original Roadmap publication, the identified barriers and solutions were judged still relevant, and progress has been slow. This 2020 Roadmap update reviews the significant changes since 2017 and identifies priority areas for achieving the goals of reducing death and disability related to AF, particularly targeted at low-middle income countries. These include advocacy to increase appreciation of the scope of the problem; plugging gaps in guideline management and prevention through physician education, increasing patient health literacy, and novel ways to increase access to integrated healthcare including mHealth and digital transformations; and greater emphasis on achieving practical solutions to national and regional entrenched barriers. Despite the advances reviewed in this update, the task will not be easy, but the health rewards of implementing solutions that are both innovative and practical will be great.
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11
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, Meir ML, Lane DA, Lebeau JP, Lettino M, Lip GY, Pinto FJ, Neil Thomas G, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. Guía ESC 2020 sobre el diagnóstico y tratamiento de la fibrilación auricular, desarrollada en colaboración de la European Association of Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42:373-498. [PMID: 32860505 DOI: 10.1093/eurheartj/ehaa612] [Citation(s) in RCA: 5051] [Impact Index Per Article: 1683.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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13
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Insights Into Direct Oral Anticoagulant Therapy Implementation of Stroke Survivors with Atrial Fibrillation in an Ambulatory Setting. J Stroke Cerebrovasc Dis 2020; 30:105530. [PMID: 33333334 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To describe how stroke survivors with atrial fibrillation implement direct oral anticoagulant treatment and propose appropriate metrics to describe adherence. MATERIALS AND METHODS Stroke patients with atrial fibrillation electronically recorded their self-administered direct oral anticoagulants (apixaban, dabigatran, edoxaban, rivaroxaban) during a 6-month observation phase after hospitalisation for ischemic stroke. Taking and timing adherence, correct dosing days, drug holidays, time of the day and day of the week subsets, dose-to-dose intervals and longest intervals between two consecutive doses were calculated from electronic monitoring data to describe and discuss the implementation phase of adherence. RESULTS Data from 41 patients were analysed. Median age was 77 (IQR = 69-84), 63.4% were male and the majority suffered a mild stroke (median NIHSS: 1). Mean taking and timing adherence exceeded 90%. Correct dosing occurred in 86.6% of the days. Seven patients (17.1%) had intake pauses of three or more consecutive days. Patients with twice-daily regimen (70.7%) had higher taking adherence in the morning than in the evening (94.4% versus 89.9%; p = 0.001). No therapy- or anamneses-related characteristic was associated with taking adherence. CONCLUSIONS Although adherence to direct oral anticoagulants of stroke patients with atrial fibrillation exceeded 90%, deviant intake patterns such as drug holidays and missed evening doses were common and raise concerns. Appropriate adherence metrics calculated from electronic monitoring data may guide healthcare professionals elucidating patient-tailored adherence-enhancing interventions. ClinicalTrials.gov registration number: NCT03344146.
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14
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Barrios V, Escobar C, Barón G, Gómez-Doblas J, Recalde E, Segura L, Alvarez P, Alonso F, Toril J, Chopo JM. Quality of life, medication adherence and satisfaction with anticoagulant treatment (dabigatran vs vitamin K antagonists) according to thromboembolic risk. Data from the CAPANA study. Int J Clin Pract 2020; 74:e13605. [PMID: 32648644 DOI: 10.1111/ijcp.13605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
| | | | - Gonzalo Barón
- Cardiology department, Hospital Virgen del Rocío, Sevilla, Spain
| | - Juanjo Gómez-Doblas
- Cardiology department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Esther Recalde
- Cardiology department, Hospital de Basurto, Bilbao, Spain
| | - Luis Segura
- Cardiology department, Hospital Clínic Creu Blanca, Barcelona, Spain
| | - Pere Alvarez
- Cardiology department, Fundación Hayge, Barcelona, Spain
| | | | - Jesús Toril
- Cardiology department, Centre Medic Castelldefels, Barcelona, Spain
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15
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Toscos T, Coupe A, Wagner S, Ahmed R, Roebuck A, Flanagan M, Drouin M, Mirro M. Engaging Patients in Atrial Fibrillation Management via Digital Health Technology: The Impact of Tailored Messaging. J Innov Card Rhythm Manag 2020; 11:4209-4217. [PMID: 32874747 PMCID: PMC7452738 DOI: 10.19102/icrm.2020.110802] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/17/2020] [Indexed: 01/08/2023] Open
Abstract
Patients with atrial fibrillation (AF) demonstrate persistent knowledge gaps regarding their condition and a substandard adherence to oral anticoagulant (OAC) medication, which contribute to thromboembolic stroke and other clot-related complications. Tailored patient education and medication reminders may help reduce these negative health outcomes. We sought to improve disease knowledge and medication adherence among a sample of AF patients using tailored education and nudges. The intervention leveraged three digital health technologies: a patient portal, an electronic-prescribing data feed, and a smart pill bottle. The content of the educational messaging, nudges, and cadence were tailored according to findings from our user-centered design studies and delivered via a patient portal (MyChart®; Epic Systems, Verona, WI, USA), with which participants were familiar. In a six-month randomized controlled trial with parallel groups, we used MyChart® to send educational messages and medication reminders according to a decision tree that emerged from our prior user-centered design studies. The intervention group demonstrated higher AF knowledge at study completion than the control group and more MyChart® logins throughout the trial, suggesting intervention uptake. Women were more adherent than men and patients diagnosed more than one year ago were more adherent than those with more recent diagnoses. The intervention and control group adherence rates were 93.1% and 89.5%, respectively; intervention effect was moderated by age, medication type, and prior MyChart® use. Within the intervention group, younger patients, those taking once-daily rivaroxaban, and those who were less active MyChart® users prior to the study benefited relative to their control group counterparts. Tailored educational and reminder messages contributed to increased adherence and disease knowledge among AF patients, though certain patient characteristics moderated the intervention's effectiveness. Technology-based health interventions can be useful for older adults with effective tailoring and training.
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Affiliation(s)
- Tammy Toscos
- Parkview Mirro Center for Research and Innovation, Health Services and Informatics Research Department, Parkview Health, Fort Wayne, IN 46845, USA
| | - Amanda Coupe
- Parkview Mirro Center for Research and Innovation, Health Services and Informatics Research Department, Parkview Health, Fort Wayne, IN 46845, USA
| | - Shauna Wagner
- Parkview Mirro Center for Research and Innovation, Health Services and Informatics Research Department, Parkview Health, Fort Wayne, IN 46845, USA
| | - Ryan Ahmed
- Parkview Mirro Center for Research and Innovation, Health Services and Informatics Research Department, Parkview Health, Fort Wayne, IN 46845, USA
| | - Amelia Roebuck
- Parkview Mirro Center for Research and Innovation, Health Services and Informatics Research Department, Parkview Health, Fort Wayne, IN 46845, USA
| | - Mindy Flanagan
- Parkview Mirro Center for Research and Innovation, Health Services and Informatics Research Department, Parkview Health, Fort Wayne, IN 46845, USA
| | - Michelle Drouin
- Parkview Mirro Center for Research and Innovation, Health Services and Informatics Research Department, Parkview Health, Fort Wayne, IN 46845, USA
| | - Michael Mirro
- Parkview Mirro Center for Research and Innovation, Health Services and Informatics Research Department, Parkview Health, Fort Wayne, IN 46845, USA
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16
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Fitzpatrick C, Gillies C, Seidu S, Kar D, Ioannidou E, Davies MJ, Patel P, Gupta P, Khunti K. Effect of pragmatic versus explanatory interventions on medication adherence in people with cardiometabolic conditions: a systematic review and meta-analysis. BMJ Open 2020; 10:e036575. [PMID: 32709649 PMCID: PMC7380877 DOI: 10.1136/bmjopen-2019-036575] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/07/2020] [Accepted: 06/16/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To synthesise findings from randomised controlled trials (RCTs) of interventions aimed at increasing medication adherence in individuals with type 2 diabetes (T2DM) and/or cardiovascular disease (CVD). And, in a novel approach, to compare the intervention effect of studies which were categorised as being more pragmatic or more explanatory using the Pragmatic-Explanatory Continuum Indicator Summary-2 (PRECIS-2) tool, to identify whether study design affects outcomes. As explanatory trials are typically held under controlled conditions, findings from such trials may not be relatable to real-world clinical practice. In comparison, pragmatic trials are designed to replicate real-world conditions and therefore findings are more likely to represent those found if the intervention were to be implemented in routine care. DESIGN Systematic review and meta-analysis. DATA SOURCES Ovid Medline, Ovid Embase, Web of Science and CINAHL from 1 January 2013 to 31 December 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES RCTs lasting ≥3 months (90 days), involving ≥200 patients in the analysis, with either established CVD and/or T2DM and which measured medication adherence. From 4403 citations, 103 proceeded to full text review. Studies published in any language other than English and conference abstracts were excluded. MAIN OUTCOME MEASURE Change in medication adherence. RESULTS Of 4403 records identified, 34 studies were considered eligible, of which 28, including 30 861 participants, contained comparable outcome data for inclusion in the meta-analysis. Overall interventions were associated with an increase in medication adherence (OR 1.57 (95% CI: 1.33 to 1.84), p<0.001; standardised mean difference 0.24 (95% CI: -0.10 to 0.59) p=0.101). The effectiveness of interventions did not differ significantly between studies considered pragmatic versus explanatory (p=0.598), but did differ by intervention type, with studies that included a multifaceted rather than a single-faceted intervention having a more significant effect (p=0.010). The analysis used random effect models and used the revised Cochrane Risk of Bias Tool to assess study quality. CONCLUSIONS In this meta-analysis, interventions were associated with a significant increase in medication adherence. Overall multifaceted interventions which included an element of education alongside regular patient contact or follow-up showed the most promise. Effectiveness of interventions between pragmatic and explanatory trials was comparable, suggesting that findings can be transferred from idealised to real-word conditions. PROSPERO REGISTRATION NUMBER CRD42017059460.
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Affiliation(s)
- Claire Fitzpatrick
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Clare Gillies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Samuel Seidu
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Debasish Kar
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Ekaterini Ioannidou
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Prashanth Patel
- Department of Cardiovascular Sciences, University of Leicester, Leicester, Leicestershire, UK
- Department of Chemical Pathology and Metabolic Diseases, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Pankaj Gupta
- Department of Cardiovascular Sciences, University of Leicester, Leicester, Leicestershire, UK
- Department of Chemical Pathology and Metabolic Diseases, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
- NIHR CLAHRC East Midlands, Leicester, UK
- NIHR ARC East Midlands, Leicester, UK
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17
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Toscos TR, Coupe A, Wagner S, Drouin M, Roebuck AE, Daley CN, Carpenter MD, Mirro MJ. Can nurses help improve self-care of patients living with atrial fibrillation? A focus group study exploring patients' disease knowledge gaps. Nurs Open 2020; 7:998-1010. [PMID: 32587718 PMCID: PMC7308702 DOI: 10.1002/nop2.472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 12/07/2019] [Accepted: 02/16/2020] [Indexed: 12/18/2022] Open
Abstract
Aims To identify knowledge gaps and preferences for educational material to improve nurse-patient communication and self-care. Design Using a mixed-methods design, we conducted focus groups and quantitative surveys. Methods We conducted three focus groups with atrial fibrillation (AF) patients and support persons (N = 17 participants; 66 ± 16 years) at critical treatment junctures (recent diagnosis or medication switch). Patients and support persons were also surveyed on patient activation (self-management skills and knowledge), medication adherence, AF knowledge and health literacy. Iterative thematic analysis was performed using focus group transcripts. Results Although most participants had adequate health literacy, most reported gaps in AF knowledge. Participants lacked disease-related knowledge and were unsure how to manage health behaviours (e.g. diet and exercise). Few felt they received adequate education from their healthcare provider. Results emphasize the need for consistent information from nursing staff, in lay language, via both electronic and printed means.
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Affiliation(s)
- Tammy R. Toscos
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
- Indiana University School of Informatics and ComputingIndianapolisIndiana
| | - Amanda Coupe
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
| | - Shauna Wagner
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
| | - Michelle Drouin
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
- Psychology DepartmentPurdue University Fort WayneFort WayneIndiana
| | - Amelia E. Roebuck
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
| | - Carly N. Daley
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
- Indiana University School of Informatics and ComputingIndianapolisIndiana
| | - Maria D. Carpenter
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
| | - Michael J. Mirro
- Parkview Mirro Center for Research & InnovationParkview Health SystemFort WayneIndiana
- Indiana University School of Informatics and ComputingIndianapolisIndiana
- Indiana University School of MedicineIndianapolisIndiana
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18
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Barrios V, Escobar C, Gómez-Doblas JJ, Fernández-Dueñas J, Garrido RR, Rodríguez JP, Sánchez JU, Arellano-Rodrigo E, Donado E. Patients' perceptions with dabigatran in patients with atrial fibrillation previously treated with vitamin K antagonists. J Comp Eff Res 2020; 9:615-625. [PMID: 32469278 DOI: 10.2217/cer-2020-0001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To analyze the perception of anticoagulation with dabigatran in patients with nonvalvular atrial fibrillation previously treated with vitamin K antagonists over a 6-month period. Materials & methods: This is a prospective, noninterventional, noncontrolled, multicenter study. To assess patients' perceptions, PACT-Q2 questionnaire was completed. Results: Six hundred and fifty nine patients (73.1 ± 9.4 years, CHA2DS2-VASc 3.6 ± 1.6) were included. At baseline, the convenience and satisfaction scores were 60.9 ± 24.9 and 49.9 ± 17.7, respectively. The scores significantly increased along the study. Convenience score was higher in males and in patients with low-moderate thromboembolic risk. Satisfaction score was higher in females. Only 8.0% of patients discontinued dabigatran (3.7% due to side effects). Conclusion: Convenience and satisfaction scores for nonvalvular atrial fibrillation patients treated with dabigatran at 6 months were significantly better than with previous vitamin K antagonists.
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Affiliation(s)
- Vivencio Barrios
- Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Carlos Escobar
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Juan José Gómez-Doblas
- Cardiology Department, Hospital Clínico Universitario Virgen de la Victoria, CIBERCV, Málaga, Spain
| | | | | | | | | | | | - Esther Donado
- Medical Affairs Department, Boehringer-Ingelheim, Sant Cugat del Vallès, Barcelona, Spain
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19
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Tzikas A, Samaras A, Kartas A, Vasdeki D, Fotos G, Dividis G, Paschou E, Forozidou E, Tsoukra P, Kotsi E, Goulas I, Karvounis H, Giannakoulas G. Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with non-valvular Atrial Fibrillation (MISOAC-AF): a randomized clinical trial. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:f63-f71. [PMID: 32339234 DOI: 10.1093/ehjcvp/pvaa039] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/05/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022]
Abstract
AIMS We aimed to assess the impact of an educational, motivational intervention on the adherence to oral anticoagulation (OAC) in patients with non-valvular atrial fibrillation (AF). METHODS AND RESULTS Hospitalized patients with non-valvular AF who received OAC were randomly assigned to usual medical care or a proactive intervention, comprising motivational interviewing, and tailored counselling on medication adherence. The primary study outcome was adherence to OAC at 1 year, which was evaluated according to proportion of days covered (PDC) by OAC regimens and was assessed through nationwide registers of prescription claims. Secondary outcomes included the rate of persistence to OAC, gaps in treatment, and clinical events. A total of 1009 patients were randomized, 500 in the intervention group and 509 in the control group. At 1-year follow-up, 77.2% (386/500) of patients in the intervention group were adherent (PDC > 80%), compared with 55% (280/509) in the control group [adjusted odds ratio (aOR) 2.84, 95% confidence interval (CI) 2.14-3.75; P < 0.001]. Mean PDC ± standard deviation was 0.85 ± 0.26 and 0.75 ± 0.31, respectively (P < 0.001). Patients that received the intervention were more likely to persist in their OAC therapy at 1 year (aOR 2.42, 95% CI 1.71-3.41; P < 0.001). Usual medical care was associated with more major (≥3 months) treatment gaps (aOR 2.39, 95% CI 1.76-3.26; P < 0.001). Clinical events over a median follow-up period of 2 years did not differ among treatment groups. CONCLUSION In patients receiving OAC therapy for non-valvular AF, a multilevel motivational intervention significantly improved medication adherence and rate of therapy persistence, and reduced major gaps in treatment. No significant impact on clinical outcomes was observed. TRIAL REGISTRATION NUMBER NCT02941978.
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Affiliation(s)
- Apostolos Tzikas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece.,Department of Cardiology, Interbalkan European Medical Center, Asklipiou 10, Pylaia, Thessaloniki 55535, Greece
| | - Athanasios Samaras
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Anastasios Kartas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Dimitra Vasdeki
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - George Fotos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - George Dividis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Eleni Paschou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Evropi Forozidou
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Paraskevi Tsoukra
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Eleni Kotsi
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Ioannis Goulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - Haralambos Karvounis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
| | - George Giannakoulas
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, St. Kiriakidi 1, Thessaloniki 54636, Greece
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20
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Montalescot G, Brotons C, Cosyns B, Crijns HJ, D'Angelo A, Drouet L, Eberli F, Lane DA, Besse B, Chan A, Vicaut E, Darius H. Educational Impact on Apixaban Adherence in Atrial Fibrillation (the AEGEAN STUDY): A Randomized Clinical Trial. Am J Cardiovasc Drugs 2020; 20:61-71. [PMID: 31243691 PMCID: PMC6978445 DOI: 10.1007/s40256-019-00356-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction Adherence to non-vitamin-K oral anticoagulants (NOACs) may be lower than to vitamin K antagonists because NOACs do not require routine monitoring. Objective We assessed the impact of an educational program on adherence and persistence with apixaban in patients with non-valvular atrial fibrillation (NVAF). Methods Patients with NVAF eligible for NOACs with one or more stroke risk factor (prior stroke/transient ischemic attack, age ≥ 75 years, hypertension, diabetes, or symptomatic heart failure) were randomized (1:1) to standard of care (SOC) or SOC with additional educational (information booklet, reminder tools, virtual clinic access). The primary outcome was adherence to apixaban (2.5 or 5 mg twice daily) at 24 weeks. Patients receiving the educational program were re-randomized (1:1) to continue the program for 24 further weeks or to switch to secondary SOC. Implementation adherence and persistence were reassessed at 48 weeks. Results In total, 1162 patients were randomized (SOC, 583; educational program, 579). Mean implementation adherence ± standard deviation (SD) at 24 weeks was 91.6% ± 17.1 for SOC and 91.9% ± 16.1 for the educational program arm; results did not differ significantly between groups at any time-point. At 48 weeks, implementation adherence was 90.4% ± 18.0, 90.1% ± 18.6, and 89.3% ± 18.1 for continued educational program, SOC, and secondary SOC, respectively; and corresponding persistence was 86.1% (95% confidence interval [CI] 81.3–89.7), 85.2% (95% CI 81.5–88.2), and 87.8% (95% CI 83.4–91.1). Serious adverse events were similar across groups. Conclusion High implementation adherence and persistence with apixaban were observed in patients with NVAF receiving apixaban. The educational program did not show additional benefits. Clinical trial registration This study is registered at ClinicalTrials.gov [NCT01884350]. Electronic supplementary material The online version of this article (10.1007/s40256-019-00356-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gilles Montalescot
- Sorbonne University, ACTION Study Group, Institut de Cardiologie (AP-HP), Centre Hospitalier Universitaire Pitié-Salpêtriėre, 47 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Carlos Brotons
- Sardenya Primary Health Care Centre-Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Bernard Cosyns
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Harry J Crijns
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Armando D'Angelo
- Coagulation Service and Thrombosis Research Unit, Scientific Institute San Raffaele, Milan, Italy
| | | | - Franz Eberli
- Department of Cardiology, Stadtspital Triemli, Zurich, Switzerland
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, L7 8TX, United Kingdom
| | - Bruno Besse
- Global Clinical Research, Bristol-Myers Squibb, Paris, France
| | - Anthony Chan
- Internal Medicine, Pfizer Healthcare Ireland, Dublin, Ireland
| | - Eric Vicaut
- Université Paris 7, the ACTION Study Group, Methodology and Statistical Unit, Centre Hospitalier Universitaire Lariboisière (AP-HP), Paris, France
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