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Krittayaphong R, Winijkul A, Methavigul K, Chichareon P, Lip GYH. Clinical outcomes of patients with atrial fibrillation in relation to multimorbidity status changes over time and the impact of ABC pathway compliance: a nationwide cohort study. J Thromb Thrombolysis 2024:10.1007/s11239-024-03007-9. [PMID: 38981981 DOI: 10.1007/s11239-024-03007-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 07/11/2024]
Abstract
Patients with atrial fibrillation (AF) commonly have associated comorbidities. The primary aim was to determine the effect of increasing numbers of comorbidity on clinical outcomes. The secondary aims were (1) the association of comorbidities with oral anticoagulants (OAC) discontinuation, and quality control, (2) the impact of holistic care based on the ABC pathway on clinical outcomes. The primary outcome was the composite of all-cause death, ischemic stroke/systemic embolism, major bleeding, and heart failure. A total of 3405 patients were enrolled; mean age 67.8 ± 11.3 years, 41.8% female. Compared to low comorbidity group [n = 897 (26.3%)], hazard ratios (HR) and 95% confidence intervals (CI) for the composite outcome in the high [n = 929 (27.3%)] and moderate comorbidity [n = 1579 (46.4%)] groups were 5.40 (4.20-6.94) and 2.54 (1.97-3.27), respectively. ABC pathway adherence was associated with reduction of the composite outcome overall (HR 0.63; 0.54-0.74). High comorbidity adversely impacted on OAC use, OAC discontinuation, and quality of warfarin control. If quality of anticoagulation control was included as part of the ABC pathway adherence, the reduction in composite outcome risk was greater (HR 0.46; 0.36-0.58). During 3-year follow-up, 33.9% changed from low- to the moderate-high comorbidity groups and 22.3% changed from moderate- to the high comorbidity group. In conclusion, comorbidity burden in AF patients is an important determinant of clinical outcomes, and changed over time. OAC use, OAC discontinuation, and quality of OAC control were impacted by comorbidity burden. ABC pathway adherence was associated with a reduced risk of adverse clinical outcomes.
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Affiliation(s)
- Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
| | - Arjbordin Winijkul
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Komsing Methavigul
- Department of Cardiology, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Ply Chichareon
- Cardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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2
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Zhang X, Wang W, Zeng J, Ye Q, Lai X, Cai X, Diao X, Huang J, Li K. Adherence to the atrial fibrillation better care pathway and its associated factors among rural patients with atrial fibrillation in China: A cross-sectional study. Heart Lung 2024; 66:23-30. [PMID: 38520987 DOI: 10.1016/j.hrtlng.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The atrial fibrillation better care (ABC) pathway is an effective strategy for the integrated management of atrial fibrillation (AF). Current data on adherence to the ABC pathway among rural patients with AF in China are limited. OBJECTIVES To investigated adherence to the ABC pathway and its associated factors among rural patients with AF in China. METHODS In the cross-sectional study, we recruited 870 rural patients with AF from July 2022 to July 2023 in China. AF-related sociodemographic and clinical data was collected. RESULTS Among the 870 rural patients with AF, 437 (50.23 %) were male, 714 (82.07 %) were ≥65 years old. The level of adherence to ABC pathway was extremely low (5.75 %), and its associated factors included patients ≥75 years (compared with those <65 years, OR=0.165, 95 %CI: 0.065-0.417, P < 0.001), junior middle school and senior middle school education or above (compared with primary school education or below, OR=3.441, 95 %CI: 1.144-10.351, P = 0.028; OR=11.438, 95 %CI: 3.758-34.814, P < 0.001), average monthly household income per capita 1000-3000 RMB and >3000 RMB (compared with <1000 RMB, OR=3.993, 95 %CI: 1.343-11.877, P = 0.013; OR=4.474, 95 %CI: 1.478-13.541, P = 0.008), persistent AF (compared with paroxysmal AF, OR=0.062, 95 %CI: 0.008-0.466, P = 0.007) and multimorbidity (OR=0.356, 95 %CI: 0.163-0.781, P = 0.010). CONCLUSIONS There is an urgent need to develop targeted interventions and national policies to improve the adherence to the ABC pathway of rural AF patients in China.
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Affiliation(s)
- Xiaomin Zhang
- School of Nursing, Sun Yat-Sen University, No.74 Zhong Shan Second Road, Guangzhou 510080, China
| | - Wenxuan Wang
- School of Nursing, Sun Yat-Sen University, No.74 Zhong Shan Second Road, Guangzhou 510080, China
| | - Jianqing Zeng
- School of Nursing, Sun Yat-Sen University, No.74 Zhong Shan Second Road, Guangzhou 510080, China
| | - Qirao Ye
- Department of Cardiology, People's Hospital of Shangyou County, Ganzhou, China
| | - Xinwei Lai
- Department of Cardiology, People's Hospital of Shangyou County, Ganzhou, China
| | - Xiaomei Cai
- Chronic Disease Management Center, People's Hospital of Shangyou County, Ganzhou, China
| | - Xiulin Diao
- Department of Cardiology, People's Hospital of Shangyou County, Ganzhou, China
| | - Jun Huang
- Department of Geriatrics, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhong Shan Second Road, Guangzhou 510080, China
| | - Kun Li
- School of Nursing, Sun Yat-Sen University, No.74 Zhong Shan Second Road, Guangzhou 510080, China.
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Aljofan M, Oshibayeva A, Moldaliyev I, Saruarov Y, Maulenkul T, Gaipov A. The rate of medication nonadherence and influencing factors: A systematic Review. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Lack of adherence to recommended therapy will reduce its effectiveness and can subsequently lead to disease progression, disabilities or even death. A vast number of research studies have emphasized the magnitude of medication nonadherence and its effect on treatment outcomes, patient’s health, healthcare providers and the associated costs; medication nonadherence remains a major concern that is believed to be widely practiced amongst medication taking patients. The current systemic review aims to cohere the available evidence regarding medication nonadherence rate, practices, and potential affecting factors and predictors. A search through different databases was conducted, including PubMed, Medline, and CINHAL for recently published research articles, within five years. The terms used for the search include medication nonadherence, medication nonadherence, factors affecting medication nonadherence and predictors of medication nonadherence. The search was limited to human subjects, English language journal articles and exclusion of review articles, case studies, and data from clinical trials as patient adherence is closely observed.<br />
The search resulted in 667 articles and only 65 articles were included and further screened. However, according to our exclusion criteria, 15 articles only were included in this review. The three most reported practices of medication nonadherence are prescription abandonment, nonconforming, and non-persistence. There are five reported factors that may lead to nonadherence practices such as socioeconomic-related factors, healthcare system-related factors, patient-related factors, disease-related factors, and therapy-related factors. In conclusion, medication nonadherence practice is a multi-dimensional phenomenon that requires a multi-targeted solution.
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Affiliation(s)
- Mohamad Aljofan
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana, KAZAKHSTAN
| | - Ainash Oshibayeva
- Department of Medicine, Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkistan, KAZAKHSTAN
| | - Ikilas Moldaliyev
- Department of Medicine, Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkistan, KAZAKHSTAN
| | - Yerbolat Saruarov
- Department of Medicine, Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkistan, KAZAKHSTAN
| | - Tilektes Maulenkul
- Department of Medicine, Khoja Akhmet Yassawi International Kazakh-Turkish University, Turkistan, KAZAKHSTAN
| | - Abduzhappar Gaipov
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, KAZAKHSTAN
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Wang Z, Wu N, Wu F, Zhang L, Gao X, Yang Y, Li M, Wan Q, Chen M. Neurology care and the long-term outcomes of atrial fibrillation-related ischaemic stroke in China: median 3-year outcome from a high volume academic tertiary hospital. BMJ Open 2023; 13:e066474. [PMID: 36731927 PMCID: PMC9896235 DOI: 10.1136/bmjopen-2022-066474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The initial medical contact of patients with atrial fibrillation (AF) and ischaemic stroke is often performed by neurologists. However, when stand care with oral anticoagulants (OACs) adherence and persistence was emphasised by cardiologists, data regarding the gap between current neurology care and standard care from Chinese tertiary hospitals is scarce and the long-term outcome is unknown. This study was to investigate the AF detection rate, the use of anticoagulation therapy and posthospital clinical outcomes associated with neurology care in patients with AF and ischaemic stroke in China. DESIGN A retrospective cohort study. SETTING Clinical data of all patients who had an ischaemic stroke discharged from the neurologic department of a high-volume academic hospital from 1 January 2013 to 31 December 2017 were analysed and patients were followed. PARTICIPANTS Patients diagnosed with ischaemic stroke and AF were included. MAIN OUTCOME MEASURES The usage of anticoagulation at discharge, the posthospital restroke rate and all-cause mortality. RESULTS Among 5797 patients who had an ischaemic stroke, 373 (6.43%) patients were diagnosed with AF during hospitalisation. Among them, only 198 (53.66%) patients were on anticoagulation therapy at discharge. A total of 325 (88.08%) patients were accessible and received follow-up. After a median 3-year follow-up, 103 (31.69%) patients died due to all causes. Among them, 53 (16.31%) patients died from recurrent stroke. And 86 (26.46%) patients restroked. In multivariable analysis, patients without anticoagulation therapy, muscle strength<grade 3 at discharge, coronary artery disease and advanced age predicted the recurrent stroke. CONCLUSIONS Secondary stroke prevention in AF patients associated with neurology care is challenging in China, as manifested by a lower AF detection rate, significant underuse of OACs, high mortality and recurrent stroke rate. Efforts to increasing the AF detection rate and reinforce education on neurologists should be made to improve neurology care and intensify posthospital management in such patients.
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Affiliation(s)
- Zidun Wang
- Division of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Nan Wu
- Gusu School,Nanjing Medical University, Nanjing, China
| | - Fengming Wu
- Division of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Lian Zhang
- Division of Neurology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Xiaoyuan Gao
- Division of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Yilan Yang
- Division of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Mingfang Li
- Division of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Qi Wan
- Division of Neurology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
| | - Minglong Chen
- Division of Cardiology, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, Jiangsu, China
- Gusu School,Nanjing Medical University, Nanjing, China
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5
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Bonsu KO, Young SW, Lee T, Nguyen HV, Chitsike RS. Self-reported adherence to direct oral anticoagulants versus warfarin therapy in a specialized thrombosis service-a cross-sectional study of patients in a Canadian Health Region. Eur J Clin Pharmacol 2023; 79:117-125. [PMID: 36399203 DOI: 10.1007/s00228-022-03418-8] [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: 07/14/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Direct oral anticoagulants (DOACs) have a better safety and efficacy profile than warfarin and are currently recommended for stroke prevention in non-valvular atrial fibrillation (AF) and treatment of venous thromboembolism (VTE). Given that DOACs do not require regular laboratory monitoring compared to warfarin, patients' interactions with the health care system is reduced. Adequate adherence to DOACs is important and reported adherence to anticoagulation is unclear in clinical practice. This study aims to assess self-reported adherence to oral anticoagulants in a specialized Adult Outpatient Thrombosis Service (TS). METHODS: This cross-sectional study included patients aged ≥ 18 years who were prescribed an oral anticoagulant and had attended at least one appointment with an Adult Outpatient Thrombosis Service (TS) between October 10, 2017, and May 31, 2019. Adherence to oral anticoagulant therapy was assessed using the 12-item validated Adherence to Refills and Medications Scale (ARMS) score. Logistic regression analyses were used to evaluate association between patient characteristics and medication adherence. Adherence rates in DOACs and warfarin were compared. RESULTS Three hundred and ninety-nine patients completed and returned the survey. Of the 399 who completed the survey, 74% were prescribed DOACs and 26% received warfarin. Most of the patients (89.3%) were ≥ 50 years of age and half (57.3%) were male. About two-thirds (67%) had at least post-secondary education. The duration of anticoagulation use differed between patients on DOAC and warfarin; a greater proportion of those who had used anticoagulants for less than 1 year was on DOACs compared to warfarin (20.9% vs 4.9%, p = 0.001). For patients who had been on anticoagulation for > 5 years, the proportion of warfarin patients was greater than DOAC (57.8% vs 20.5%, p = 0.001). Self-reported adherence to oral anticoagulant therapy using the 12-item ARMS scale for warfarin and DOACs were 87.3% and 90.9%, respectively. Among the warfarin users, patient satisfaction with TS was associated with medication adherence (OR = 0.22; 95% CI: 0.05-0.89). CONCLUSIONS Self-reported medication adherence was similar between warfarin and DOACs. Since suboptimal adherence is associated with poor clinical outcomes and increased costs, various stakeholders should emphasize the importance of medication adherence to oral anticoagulants at each patient encounter.
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Affiliation(s)
- Kwadwo Osei Bonsu
- School of Pharmacy, Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada.
| | - Stephanie W Young
- School of Pharmacy, Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada.,Pharmacy Program, Eastern Region Health Authority, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada
| | - Tiffany Lee
- School of Pharmacy, Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada.,Pharmacy Program, Eastern Region Health Authority, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada
| | - Hai V Nguyen
- School of Pharmacy, Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada
| | - Rufaro S Chitsike
- Division of Hematology, Eastern Region Health Authority, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada.,Division of Medicine (Hematology), Memorial University of Newfoundland, 300 Prince Philip Drive, St John's, NL, A1B 3V6, Canada
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6
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Wei Y, Zeng Q, Cai L, Wang X, Wang B, Shen C, Li C, Wang C, Shen Y, Yang S, Wu X, Liu Y, Xu J, Lu X, Chen S, Zhou G, Liu S. Contemporary survival and anticoagulation of patients with atrial fibrillation: A community based cohort study in China. Front Cardiovasc Med 2022; 9:911393. [PMID: 35966522 PMCID: PMC9363600 DOI: 10.3389/fcvm.2022.911393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Backgrounds The understanding of death in patients with atrial fibrillation (AF) in China is limited. This study aimed to assess the contemporary survival of AF patients in China and to explore risk factors for deaths. Methods This was a prospective community-based cohort study including 559 AF patients, who were followed-up from July 2015 to December 2020. Results During 66-month follow-up, there were 200 deaths (56.5% cardiovascular, 40.0% non-cardiovascular, and 3.5% unknown causes) among 559 AF patients with the median age of 76 years. The top three causes of death were heart failure (33.0%), ischemic stroke (17.0%) and cancer (16.5%). Multivariate Cox regression analysis indicated baseline variables positively associated with all-cause death were age (HR: 1.10, 95% CI: 1.08–1.13), AF subtype (HR: 1.37, 95% CI: 1.08–1.73), prior myocardial infarction (HR: 3.40, 95% CI: 1.48–7.78), previous tumor (HR: 2.61, 95% CI: 1.37–4.98), hypoglycemic therapy at baseline (HR: 1.81, 95% CI: 1.13–2.91), but body weight (HR: 0.98, 95% CI: 0.97–1.00) and use of calcium channel blocker (CCB) (HR: 0.62, 95% CI: 0.41–0.95) played a protective role to all-cause death. Of patients who were alive at the end of follow-up, 24.0% were on oral anticoagulants (OAC) alone, 4.5% on dual antithrombotic therapy, 33.1% on antiplatelet agents alone and 38.4% weren't on any antithrombotic medication. Conclusion Ischemic stroke still remains one of the leading causes of death and OAC is seriously underused in AF patients in China. Independent risk factors for death are age, AF subtype, previous tumor, prior myocardial infarction, hypoglycemic therapy, low body weight and no CCB use. Clinical Trial Registration http://www.chictr.org.cn/ (ChiCTR-ICR-15007036).
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Affiliation(s)
- Yong Wei
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingye Zeng
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lidong Cai
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xingjie Wang
- Shihudang Community Health Care Center, Shanghai, China
| | - Bin Wang
- Dongjing Community Health Care Center, Shanghai, China
| | - Chaoying Shen
- Xiaokunshan Community Health Care Center, Shanghai, China
| | - Chao Li
- Yexie Community Health Care Center, Shanghai, China
| | - Caihong Wang
- Xinbang Community Health Care Center, Shanghai, China
| | - Yahong Shen
- Maogang Community Health Care Center, Shanghai, China
| | - Shunhong Yang
- Chedun Community Health Care Center, Shanghai, China
| | - Xiaoyu Wu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Liu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juan Xu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Lu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Songwen Chen
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Genqing Zhou
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Genqing Zhou
| | - Shaowen Liu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Shaowen Liu
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de Sousa WJFN, Guimarães NS, Viana CC, Machado PTS, Medeiros AF, Vianna MS, de Souza RP, Bertollo CM, Martins MAP. Factors associated with non-adherence to the use of coumarin derivatives or direct oral anticoagulants: a systematic review of observational studies. Br J Clin Pharmacol 2022; 88:4688-4707. [PMID: 35680285 DOI: 10.1111/bcp.15437] [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: 11/07/2021] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022] Open
Abstract
Non-adherence to thromboprophylaxis treatment with oral anticoagulants (OAC) is a public health problem and may be associated with high mortality rates. We sought to synthesize the factors associated with non-adherence to therapy with coumarin derivatives or direct oral anticoagulants. A systematic review was performed at electronic databases Medline, Embase, CINAHL, Lilacs and grey literature (Google Scholar, MedNar, OpenGray, ProQuest Dissertations and Theses and hand search). This study was conducted according to Cochrane's method and PRISMA. The registration on PROSPERO is CRD42020223555. Overall, 1,270 studies were identified and nine studies were selected for this review. In hand search, 77 studies were found, but none included. The associated factors with non-adherence were heterogeneous, and some factors were described as both risk and protection for non-adherence, with few variables showing consistent results among the studies. Variables reported only as risk factors were "male sex"; "hospitalization"; "Charlson score" and "bleeding", while "white race"; CHA2 DS2 VASc (score range 2-9)" and "polypharmacy" were reported only as protective factors. Most studies did not present details in the description of concepts and methods to assess non-adherence. In clinical practice, the knowledge on factors associated with non-adherence is helpful to identifying patients at higher risk of complications that would benefit from individualized interventions.
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Affiliation(s)
- Waleska Jaclyn Freitas Nunes de Sousa
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil.,Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil
| | - Nathália Sernizon Guimarães
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil
| | - Catiane Costa Viana
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Pamela Thayna Silva Machado
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Amanda Fonseca Medeiros
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil.,Hospital Risoleta Tolentino Neves, Rua das Gabirobas, 1, Bairro Vila Cloris, Belo Horizonte, Minas Gerais, Brazil
| | - Mayara Sousa Vianna
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Renan Pedra de Souza
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas da Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Caryne Margotto Bertollo
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil.,Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Auxiliadora Parreiras Martins
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil.,Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110, Bairro Santa Efigênia, Belo Horizonte, Minas Gerais, Brazil.,Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil.,Hospital Risoleta Tolentino Neves, Rua das Gabirobas, 1, Bairro Vila Cloris, Belo Horizonte, Minas Gerais, Brazil
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8
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Zhang M, Chen J, Gao C, Gu S, Yang P, Xu Z. Application value of whole-course health management for patients with nonvalvular atrial fibrillation with oral warfarin treatment. Am J Transl Res 2022; 14:3269-3277. [PMID: 35702076 PMCID: PMC9185060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore the effect of the whole-process health management model on the compliance of oral warfarin treatment in patients with non-valvular atrial fibrillation in primary hospitals. METHODS We retrospectively analyzed the clinical data of 130 patients with non-valvular atrial fibrillation treated in the Department of Cardiovascular Medicine, Hai'an People's Hospital from January 2019 to December 2019. Among them, 63 patients who received routine continuing care were included in the control group, and 67 patients treated with whole-course health management model of primary hospitals were included in the observation group. The two groups were compared in terms of the following parameters: Warfarin anticoagulation knowledge, medication compliance, compliance rate (international normalized ratio, INR) monitoring, bleeding events (gingival bleeding, subcutaneous bleeding, gastrointestinal bleeding, etc.), embolic events (vascular thrombosis), negative emotions before and after management, and patient satisfaction. Logistic analysis was used to analyze independent risk factors affecting the effect of warfarin anticoagulation in patients with non-valvular atrial fibrillation. RESULTS Compared with the control group, the warfarin anticoagulation knowledge, medication compliance, and INR compliance rate of the observation group were significantly higher, and the incidence of adverse events was significantly lower. Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores were not significantly different between the two groups before management. After management, SAS and SDS scores decreased significantly in both groups, and were lower in the observation group compared with the control group. The management satisfaction was also significantly higher in the observation group. CONCLUSION Compared with the conventional continuation care model, the whole-process management in primary hospitals can improve patients' compliance with medical advice and treatment efficacy, with lower risk of bleeding and higher patient satisfaction, providing a better option for the out-of-hospital management of anticoagulation for non-valvular atrial fibrillation patients. Age, hypertension, diabetes, knowledge of warfarin anticoagulation and medication compliance were independent risk factors for the effect of warfarin anticoagulation in patients with non-valvular atrial fibrillation.
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Affiliation(s)
- Min Zhang
- Department of Cardiology, Hai’an People’s Hospital, Jiangsu ProvinceHai’an 226600, Jiangsu Province, China
| | - Jianjing Chen
- Department of Cardiology, Hai’an People’s Hospital, Jiangsu ProvinceHai’an 226600, Jiangsu Province, China
| | - Chunmei Gao
- Department of Cardiology, Hai’an People’s Hospital, Jiangsu ProvinceHai’an 226600, Jiangsu Province, China
| | - Shunzhong Gu
- Department of Cardiology, Hai’an People’s Hospital, Jiangsu ProvinceHai’an 226600, Jiangsu Province, China
| | - Ping Yang
- Libao Central Health Cente, Hai’an City, Jiangsu ProvinceHai’an 226600, Jiangsu Province, China
| | - Zhenlan Xu
- Department of Cardiology, Hai’an People’s Hospital, Jiangsu ProvinceHai’an 226600, Jiangsu Province, China
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Bonsu KO, Young S, Lee T, Nguyen H, Chitsike RS. Adherence to Antithrombotic Therapy for Patients Attending a Multidisciplinary Thrombosis Service in Canada - A Cross-Sectional Survey. Patient Prefer Adherence 2022; 16:1771-1780. [PMID: 35923661 PMCID: PMC9339664 DOI: 10.2147/ppa.s367105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Poor medication adherence puts patients who require antithrombotic therapy at greater risk of complications. We started a multidisciplinary Adult Outpatient Thrombosis Service in 2017 in a Canadian health authority and were interested in the level of medication adherence in the population attending. AIMS The aim of this study is to assess adherence to antithrombotic medications for patients attending a multidisciplinary Thrombosis Service. METHODS We conducted a cross-sectional survey of outpatients seen at the Thrombosis Service between 2017 and 2019 using the 12-item validated Adherence to Refills and Medications Scale (ARMS) to assess adherence to antithrombotic (anticoagulants and antiplatelet) therapy. Linear regression analysis examined the factors associated with adherence to antithrombotic therapy. RESULTS Of 1058 eligible patients, 53.2% responded to the survey. Seventeen were excluded from the analysis for missing more than 6 responses to the 12 items on the ARMS. About 55% (n = 297) were on direct oral anticoagulants (DOACs), 19% (n = 102) on warfarin, 5.0% (n = 27) on low molecular weight heparin, 3.3% (n = 18) on antiplatelet therapy and 18% (n = 96) were no longer on antithrombotic therapy. Nearly half (47%, n = 253) had taken antithrombotic therapy for 1-5 years while 28% (n = 150) and 25% (n = 137) had taken antithrombotic treatments for <1 and >5 years, respectively. Most patients (87%, n = 475) were ≥50 years and half (51%, n = 277) were male. The mean adherence score was 13.9 (SD±2.2) and 88% (n = 481) of participants were adherent to antithrombotic treatment (ARMS = 12-16). Multivariable linear regression showed that patients with post-graduate education had 0.4% lower adherence to antithrombotic therapy as compared with elementary education (β = 0.0039, p = 0.048). Patients with prior antithrombotic agent use >5 years had 0.5% lower adherence to antithrombotic treatment compared to patients with <1 year (β = 0.0047, p = 0.0244). CONCLUSION Self-reported adherence to antithrombotic therapy was high (88%) within a multidisciplinary Thrombosis Service. Patients with advanced education and prolong duration of antithrombotic therapy were more likely to have lower self-reported adherence to antithrombotic treatment.
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Affiliation(s)
- Kwadwo Osei Bonsu
- School of Pharmacy, Memorial University of Newfoundland and Labrador, St John’s, NL, A1B 3V6, Canada
- Correspondence: Kwadwo Osei Bonsu, School of Pharmacy, Memorial University of Newfoundland and Labrador, 300 Prince Philip Drive, St John’s, NL, A1B 3V6, Canada, Email
| | - Stephanie Young
- School of Pharmacy, Memorial University of Newfoundland and Labrador, St John’s, NL, A1B 3V6, Canada
- Pharmacy Program, Eastern Region Health Authority, St John’s, NL, A1B 3V6, Canada
| | - Tiffany Lee
- School of Pharmacy, Memorial University of Newfoundland and Labrador, St John’s, NL, A1B 3V6, Canada
- Pharmacy Program, Eastern Region Health Authority, St John’s, NL, A1B 3V6, Canada
| | - Hai Nguyen
- School of Pharmacy, Memorial University of Newfoundland and Labrador, St John’s, NL, A1B 3V6, Canada
| | - Rufaro S Chitsike
- Division of Medicine (Hematology), Memorial University of Newfoundland and Labrador, St John’s, NL, A1B 3V6, Canada
- Division of Hematology, Eastern Region Health Authority, St John’s, NL, A1B 3V6, Canada
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Cabral AC, Lavrador M, Fernandez-Llimos F, Castel-Branco M, Figueiredo IV. Evaluation of a sample of Portuguese hypertensive patients’ knowledge about hypertension and its influence on their beliefs and adherence to therapy. Rev Port Cardiol 2021; 41:361-367. [DOI: 10.1016/j.repc.2021.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/15/2021] [Accepted: 02/12/2021] [Indexed: 10/19/2022] Open
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Vianna MS, da Silva Praxedes MF, de Araújo VE, Ferreira CB, de Sousa WJFN, Viana CC, Martins MAP. Self-report instruments for assessing adherence to warfarin therapy: a systematic review. Eur J Clin Pharmacol 2021; 77:1765-1781. [PMID: 34292359 DOI: 10.1007/s00228-021-03168-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/30/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The assessment of adherence to warfarin therapy is useful in clinical practice due to its wide variability in dose-response and risks of complications. The aim of this study was to investigate validated instruments used to assess adherence to warfarin therapy. METHODS Information was collected from the MEDLINE (PubMed), LILACS, EMBASE, and Cochrane Library databases. Search strategies were applied for each database, with no time limit or language restriction. Inclusion criteria consisted of study participants of ≥ 18 years of age, from both sexes, on chronic anticoagulation with warfarin for any indication and the use of validated instruments to assess adherence to warfarin therapy. Exclusion criteria consisted of duplicate articles, narrative or systematic reviews, and meta-analyses, as well as case reports/series and experimental studies involving animals. Two independent reviewers performed the following steps: evaluation of titles/abstracts, selection of studies after full reading, data extraction, and evaluation of potential bias. Discrepancies were resolved by a third reviewer. RESULTS Overall, 19 articles were selected for this systematic review, including 17 cross-sectional studies, one cohort study, and one quasi-experimental study, published from 2009 to 2019. The validated instruments identified in this review were Morisky Medication Adherence Scale (MMAS), the eight-item Morisky Medication Adherence Scale (MMAS-8), Measurement of Treatment Adherence (MTA), and Brief Medication Questionnaire (BMQ). Only MMAS-8 was tested for reliability, using the internal consistency assessment, with Cronbach's α range 0.56-0.71. CONCLUSIONS This review highlighted a gap in knowledge regarding the scarcity of validated instruments to assess adherence to warfarin therapy. Limitations were found in instruments that comprised the assessment of the isolated use of medication and the lack of analysis of other relevant therapeutic aspects. Future studies are needed to develop and validate more comprehensive instruments in an attempt to assess adherence to warfarin therapy. PROSPERO Registration number CRD42019128324.
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Affiliation(s)
- Mayara Sousa Vianna
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, 31270-901, Brazil
| | - Marcus Fernando da Silva Praxedes
- Centro de Ciências da Saúde, Universidade Federal Do Recôncavo da Bahia, Av. do Cajueiro, Cajueiro, Santo Antonio de Jesus, BA, Brazil
| | - Vânia Eloisa de Araújo
- Faculdade de Odontologia, Pontifícia Universidade Católica de Minas Gerais, Av: Dom José Gaspar, 500 Coração Eucarístico, Belo Horizonte, MG, 30535-901, Brazil
| | - Carolina Barbosa Ferreira
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, 31270-901, Brazil
| | - Waleska Jaclyn Freitas Nunes de Sousa
- Faculdade de Medicina da, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Bairro Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil
| | - Catiane Costa Viana
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, 31270-901, Brazil
| | - Maria Auxiliadora Parreiras Martins
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, 31270-901, Brazil.
- Faculdade de Medicina da, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Bairro Santa Efigênia, Belo Horizonte, MG, 30130-100, Brazil.
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Park S, Jang I. Factors Affecting Medication Adherence in Patients with Mechanical Heart Valves Taking Warfarin: The Role of Knowledge on Warfarin, Medication Belief, Depression, and Self-Efficacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5214. [PMID: 34068932 PMCID: PMC8156383 DOI: 10.3390/ijerph18105214] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 01/04/2023]
Abstract
Non-adherence is highlighted as one of the main contributors to the occurrence of adverse events and negative clinical outcomes in patients treated with warfarin. The aim was to examine knowledge on warfarin, medication belief, depression, and self-efficacy as factors influencing medication adherence for anticoagulation control. This was a cross-sectional study. The participants in this study were patients who visited an outpatient clinic of cardiovascular surgery to administer anticoagulants after mechanical valve replacement surgery at a tertiary hospital in Seoul. Responses of 154 participants on questionnaires were analyzed from 10 September to 26 December 2020. Multiple regression analyses were performed to assess the factors influencing medication adherence among the patients with anticoagulation control. Factors influencing medication adherence were consuming warfarin for 3 to 5 years, awareness of target prothrombin time international normalized ratio, knowledge of warfarin, and depression. Medication beliefs and self-efficacy had no significant influence on medication adherence. The most important factors associated with medication adherence in patients with mechanical heart valves were knowledge about warfarin and depression. In the control of oral anticoagulants that require continuous management, education and providing accurate guidance is more important than personal preferences. Clinical nurses should facilitate educational programs tailored to the characteristics of the patient, including their purpose and method of taking warfarin, specific diets, their knowledge on warfarin's interaction with other drugs, symptoms of adverse events, and self-management. In addition, healthcare providers should check whether warfarin therapy is being controlled by evaluating medication adherence and depression levels among patients.
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Affiliation(s)
- Soohyun Park
- Department of Nursing, Asan Medical Center, Seoul 05505, Korea;
| | - Insil Jang
- Department of Nursing, Chung-Ang University, Seoul 06974, Korea
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Lo FMW, Wong EML, Hong FKW. The Effects of Educational Programs on Knowledge, International Normalized Ratio, Warfarin Adherence, and Warfarin-Related Complications in Patients Receiving Warfarin Therapy: An Integrative Review. J Cardiovasc Nurs 2021; 37:E32-E46. [PMID: 33657063 DOI: 10.1097/jcn.0000000000000790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Education is considered a crucial element in anticoagulation management for patients with atrial fibrillation, valvular disease, ischemic heart disease, and venous thromboembolism. However, the effects of education on the patients prescribed warfarin are seldom investigated. OBJECTIVES This integrative review was conducted to explore the effects of educational programs on patients prescribed warfarin for the aforementioned cardiovascular diseases and to identify the components of effective programs. METHODS A systematic search of clinical trials was performed in 8 databases from inception to August 2020. Two reviewers performed the eligibility assessment, methodological evaluation, and data extraction. A total of 9 studies were included and analyzed via narrative synthesis. RESULTS Nine studies involving a combined total of 1335 patients were included in the review. The findings suggest that educational programs have potential benefits related to international normalized ratio control and warfarin knowledge. However, their effects on major bleeding and thromboembolic events are unremarkable. Stronger evidence is recommended to confirm these findings, and the limited evidence examining the effects of education on warfarin adherence, minor bleeding, abnormal international normalized ratio, readmission rate, and warfarin-related mortality requires further exploration. Verbal education supported by written materials was the main educational delivery mode. A lecture length of approximately 45 minutes was likely appropriate. Notably, the integration of educational strategies, application of follow-up interventions and monitoring measures, adoption of psychological theories in program development, and inclusion of nurses or pharmacists in program conduction seemed to be effective program components. CONCLUSIONS The effects of educational programs on patients prescribed warfarin mainly for atrial fibrillation, valvular disease, ischemic heart disease, and venous thromboembolism remain inconclusive. Further research using randomized controlled trials is warranted.
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Affiliation(s)
- Flora M W Lo
- Flora M. W. Lo, MN Student, Doctor of Health Science, The Hong Kong Polytechnic University, Hong Kong. Eliza M. L. Wong, PhD Principal Research Fellow, School of Nursing, The Hong Kong Polytechnic University, Hong Kong. Felix K. W. Hong, MN Nurse, Nursing Department, Kiang Wu Hospital, Macao, China
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Song T, Xin X, Cui P, Zong M, Li X. Factors Associated with Anticoagulation Adherence in Chinese Patients with Non-Valvular Atrial Fibrillation. Patient Prefer Adherence 2021; 15:493-500. [PMID: 33688171 PMCID: PMC7935330 DOI: 10.2147/ppa.s285020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/25/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Inadequate medication adherence among patients with non-valvular atrial fibrillation (NVAF) will directly affect the efficacy and safety of anticoagulation therapy, leading to a considerable increase in the risk of ischemic stroke and death. In this study, we aim to investigate medication adherence and identify the influencing factors, including social-demographic, disease-related information and self-efficacy. PATIENTS AND METHODS We recruited 170 patients with NVAF from a tertiary hospital atrial fibrillation outpatient clinics and cardiology ward from June 2020 to September 2020. Patients who had been taking oral anticoagulation medication for at least 3 months were included. And Morisky medication adherence scale (MGL) was used to assess the adherence to anticoagulants, which scores <4 were considered as low adherence. RESULTS Fifty (29.4%) NVAF patients had a MGL score<4. Monthly income, types of comorbidities, number of drugs, and self-efficacy were determinants of anticoagulation adherence. Binomial logistic regression showed that patients had been prescribed more durgs (OR: 3.51, p=0.002), had high monthly income (OR: 7.87, p=0.001), without other diseases (OR: 8.00, p=0.005), and with higher self-efficacy (OR: 1.42, p=0.001) showed high adherence. CONCLUSION Number of drugs, types of comorbidities, monthly income, and self-efficacy were associated with the adherence of non-vitamin K antagonist oral anticoagulants (NOACs).
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Affiliation(s)
- Ting Song
- School of Nursing, Shanghai Jiaotong University, Shanghai, People’s Republic of China
| | - Xiao Xin
- Department of Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
| | - Peirong Cui
- School of Nursing, Shanghai Jiaotong University, Shanghai, People’s Republic of China
| | - Mingcan Zong
- School of Nursing, Shanghai Jiaotong University, Shanghai, People’s Republic of China
| | - Xianhua Li
- Department of Outpatient Office, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China
- Correspondence: Xianhua Li Department of Outpatient Office, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of ChinaTel +86 18917762081 Email
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Impact of adherence to warfarin therapy during 12 weeks of pharmaceutical care in patients with poor time in the therapeutic range. J Thromb Thrombolysis 2020; 51:1043-1049. [PMID: 32974757 DOI: 10.1007/s11239-020-02280-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 01/17/2023]
Abstract
Poor adherence to warfarin treatment is a contributor to poor quality of treatment, which increases the risk of bleeding and thromboembolic events. This study aims to evaluate the impact of adherence to warfarin therapy on anticoagulation quality during 12 weeks of pharmaceutical care and after 1 year of follow-up for patients with atrial fibrillation and with poor TTR. The Arrhythmia Unit of tertiary hospital in Brazil. We included 262 patients with AF and poor quality of anticoagulation therapy with warfarin (TTR < 50%). Pharmacist-driven therapy management was performed for 12 weeks and patients were also evaluated 1 year after the end of the follow-up with a pharmacist. Adherence was classified into high adherence, medium adherence and low adherence. Impact of adherence to warfarin therapy after pharmaceutical care. Of the 262 patients, 160 were high adherence, 71 were medium adherence and 31 were low adherence. No statistically significant difference is found between adherence groups in demographic and clinical variables. The TTR basal means were not different among adherence groups (p = 0.386). However, the means of TTR 12 weeks and TTR 1 year after the end of protocol were statistically different among adherence groups (p < 0.001 and p = 0.002, respectively). When we compared TTR values at different times within the adherence group, we observed that there is a statistical difference between the three TTR means (basal versus 12 weeks versus 1 year after) within the adherence group (p < 0.001). Patients with poor anticoagulation control, who adhered to the treatment with warfarin during the pharmaceutical care had better anticoagulation quality compared to those who did not adhere to the therapy with warfarin.
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Zhao S, Hong X, Cao J, Zhang J, Ma P. Current Evidence for Pharmacologic Reversal Using Direct Oral Anticoagulants: What's New? Am J Cardiovasc Drugs 2020; 20:117-123. [PMID: 31440983 DOI: 10.1007/s40256-019-00366-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Direct oral anticoagulants are increasingly used in clinical practice and have addressed many of the issues related to vitamin K antagonists. However, the lack of reversal in life-threatening situations raises concerns regarding patient safety. Thus, current research is aimed at developing reversal agents that can safely neutralize the effects of anticoagulants. We present the design and mechanisms of action of and the animal models, clinical trials, and current evidence supporting the use of these emerging reversal agents. Idarucizumab is approved in many countries, and andexanet alfa has been approved by the US FDA, whereas others are in clinical trials. In view of the results of clinical studies to date, the problems of safety, price and accessibility remain. Therefore, these antidotes are a significant step towards improving the field of urgent and emergency reversal. From a practical perspective, post-market surveillance will be crucial to monitor the safety and effectiveness of these agents.
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Affiliation(s)
- Shujuan Zhao
- Department of Pharmacy, People's Hospital of Henan Province, Zhengzhou, 450003, Henan, China
| | - Xuejiao Hong
- Department of Pharmacy, People's Hospital of Henan Province, Zhengzhou, 450003, Henan, China
| | - Jingjing Cao
- Department of Pharmacy, People's Hospital of Henan Province, Zhengzhou, 450003, Henan, China
| | - Jing Zhang
- Department of Cardiovascular Medicine, People's Hospital of Henan Province, Zhengzhou, 450003, Henan, China
| | - Peizhi Ma
- Department of Pharmacy, People's Hospital of Henan Province, Zhengzhou, 450003, Henan, China.
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Magon A, Arrigoni C, Moia M, Mancini M, Dellafiore F, Manara DF, Caruso R. Determinants of health-related quality of life: a cross-sectional investigation in physician-managed anticoagulated patients using vitamin K antagonists. Health Qual Life Outcomes 2020; 18:73. [PMID: 32178684 PMCID: PMC7077005 DOI: 10.1186/s12955-020-01326-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/11/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Literature has paid little attention in describing the specific contribution of each modifiable and non-modifiable characteristics on health-related quality of life (HRQoL) in physician-managed anticoagulated patients using vitamin K antagonists (VKAs). To describe how patients' treatment-specific knowledge, health literacy, treatment beliefs, clinical, and socio-demographic characteristics influence HRQoL in Italian physician-managed anticoagulated patients using VKAs. METHODS Cross-sectional multicentre study with a consecutive sampling strategy, enrolling 164 long-term anticoagulated patients. Clinical and socio-demographic characteristics were collected from electronic medical records. Valid and reliable questionnaires were used to collect patients' treatment-specific knowledge, health literacy, beliefs about VKAs, physical and health perceptions. RESULTS Obtaining and understanding health information (i.e., communicative health literacy) positively predicts both adequate mental (ORadjusted = 10.9; 95%CI = 1.99-19.10) and physical (ORadjusted = 11.54; 95%CI = 1.99-34.45) health perceptions. Conversely, the ability to perform proper health decision making (i.e., critical health literacy) was associated with lower rates of adequate mental health perception (ORadjusted = 0.13; 95%CI = 0.03-0.63). Further, age negatively predicted physical health perception (ORadjusted = 0.87; 95%CI = 0.81-0.93). CONCLUSIONS Health literacy plays an interesting role in predicting HRQoL. The relationship between critical health literacy and mental health perception could be influenced by some psychological variables, such as distress and frustration, which could be present in patients with higher levels of critical health literacy, as they could be more inclined for self-monitoring. For this reason, future research are needed to identify the most suitable patients' profile for each OAC-management model, by longitudinally describing the predictive performance of each modifiable and non-modifiable determinant of HRQoL.
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Affiliation(s)
- Arianna Magon
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1 - 00133, Rome, Italy.
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Marco Moia
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Michela Mancini
- Nursing Office, ASST Melegnano e della Martesana, Melzo, Italy
| | - Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Duilio F Manara
- School of Nursing, Vita-Salute San Raffaele University, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Adherence to Cardiac Medications in Patients With Atrial Fibrillation: A Pilot Study. Heart Lung Circ 2020; 29:e131-e139. [PMID: 32089489 DOI: 10.1016/j.hlc.2019.11.012] [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: 05/22/2019] [Revised: 11/13/2019] [Accepted: 11/24/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Non-adherence to medications is common in patients with atrial fibrillation (AF), increasing the risk of stroke, co-morbidities, and AF symptoms. Understanding factors influencing medication adherence is important in providing holistic care to patients with AF. This study aimed to explore medication adherence in patients with AF, and explore associations with health literacy, cognition, or AF knowledge. METHODS A single-centre pilot study, using survey questionnaires and open questions. Patients with a primary cardiac diagnosis, with AF as primary or secondary diagnosis, were eligible for recruitment. During hospitalisation, adherence to cardiac medications was assessed using the Basel Assessment of Adherence to Immunosuppressive Medication Scale (BAASIS). Health literacy, cognition, and AF knowledge were assessed through validated questionnaires. Facilitators and barriers for medication adherence were obtained through open-ended question and coded using a content analysis approach. RESULTS Fifty-four (54) patients were recruited (61% male, mean age 71±11). Twenty-two (22) participants (41%) were classified as non-adherent using the BAASIS; with a corresponding self-reported adherence of 87.7% in non-adherent participants compared to 97.8% in adherent participants. No associations were identified between medication adherence and cognition, health literacy, or AF knowledge. Facilitators for adherence included external assistance, routines, and medication knowledge, and these were reported by both adherent and non-adherent participants. Non-adherent participants reported more barriers including medication concerns, forgetfulness, and lifestyle factors. CONCLUSIONS Large numbers of AF patients are likely to be non-adherent to medications. Medication adherence is influenced by multiple factors, individual to each patient. Diverse strategies are required to ensure adherence to cardiac medications.
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Chen PT, Wang TJ, Hsieh MH, Liu JC, Liu CY, Wang KY, Laio WC. Anticoagulation adherence and its associated factors in patients with atrial fibrillation: a cross-sectional study. BMJ Open 2019; 9:e029974. [PMID: 31481562 PMCID: PMC6731875 DOI: 10.1136/bmjopen-2019-029974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To investigate anticoagulant adherence and its associated factors, including demographics, clinical variables, atrial fibrillation (AF) severity, knowledge, satisfaction with services, perceived barriers, perceived benefits, symptom severity and self-efficacy in patients with AF. DESIGN This is a cross-sectional study. PARTICIPANTS AND SETTING A convenient sample of patients with AF were recruited from cardiology clinics of two teaching hospitals in Taiwan. MEASURES Data were collected using the study questionnaires, including the AF-related symptom subscale of the AF Severity Scale, the Knowledge of Warfarin Anticoagulation Treatment Scale, the Satisfaction Scale about Service and Warfarin Treatment, the perceived benefits subscale of the Beliefs about Anticoagulation Survey, the Concerns about Anticoagulation Therapy Scale, The Self-efficacy for Appropriate Medication Use Scale and the short-form Adherence to Refills and Medications Scale. RESULTS A total of 151 patients with AF participated in the study; 53 treated with warfarin and 98 treated with novel oral anticoagulants (NOACs). The difference in adherence to warfarin (mean=8.6; SD=1.6) and NOACs (mean=8.9; SD=2.0) was statistically insignificant. Multiple linear regression analysis showed that perceived barriers (β=0.18, p=0.017) and self-efficacy (β=-0.48, p<0.001) were significant predictors of anticoagulation adherence. For every 1-unit increase in the perceived barriers, there will be a 0.18-unit increase in the adherence to anticoagulation therapy. For every 1-unit increase in the self-efficacy, there will be a 0.48-unit decrease in the adherence to anticoagulation therapy. Perceived barriers and self-efficacy collectively explained 34.0% of the variance in adherence to anticoagulation therapy (F(2,149)=38.11, p<0.001). CONCLUSION We found no better adherence to NOACs compared with warfarin. Patients with greater self-efficacy and perceived fewer barriers showed better adherence to anticoagulation therapy.
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Affiliation(s)
- Pei-Ti Chen
- Nursing, Cardinal Tien Junior College of Healthcare and Management, Taipei, Taiwan
| | - Tsae-Jyy Wang
- Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | | | - Ju-Chi Liu
- Internal Medicine, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
| | - Chieh-Yu Liu
- Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Kwua-Yun Wang
- Nursing, National Defense Medical Center, Taipei, Taiwan
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Cognitive Impairment Is Independently Associated with Non-Adherence to Antithrombotic Therapy in Older Patients with Atrial Fibrillation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152698. [PMID: 31362337 PMCID: PMC6696263 DOI: 10.3390/ijerph16152698] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/24/2019] [Accepted: 07/27/2019] [Indexed: 12/17/2022]
Abstract
Atrial Fibrillation (AF) patients could reduce their risk of stroke by using oral antithrombotic therapy. However, many older people with AF experience cognitive impairment and have limited health literacy, which can lead to non-adherence to antithrombotic treatment. This study aimed to investigate the influence of cognitive impairment and health literacy on non-adherence to antithrombotic therapy. The study performed a secondary analysis of baseline data from a cross-sectional survey of AF patients’ self-care behaviors at a tertiary university hospital in 2018. Data were collected from a total of 277 AF patients aged 65 years and older, through self-reported questionnaires administered by face-to-face interviews. Approximately 50.2% of patients were non-adherent to antithrombotic therapy. Multiple logistic regression analysis revealed that cognitive impairment independently increased the risk of non-adherence to antithrombotic therapy (odds ratio = 2.628, 95% confidence interval = 1.424–4.848) after adjustment for confounding factors. However, health literacy was not associated with non-adherence to antithrombotic therapy. Cognitive impairment is a significant risk factor for poor adherence to antithrombotic therapy. Thus, health professionals should periodically assess both cognitive function after AF diagnosis and adherence to medication in older patients. Further studies are needed to identify the factors that affect cognitive decline and non-adherence among AF patients.
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21
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Nie B, Chapman SCE, Chen Z, Wang X, Wei L. Utilization of the beliefs about medicine questionnaire and prediction of medication adherence in China: A systematic review and meta-analysis. J Psychosom Res 2019; 122:54-68. [PMID: 31006535 DOI: 10.1016/j.jpsychores.2019.03.184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Beliefs about medicines have been proposed as a strong determinant of medication adherence. It has been widely assessed using a Belief about Medicines Questionnaire (BMQ) for 20 years outside of China. OBJECTIVES To investigate the use of the BMQ in China, and to evaluate the association between beliefs about medicines and medication adherence in the Chinese population. METHODS A systematic review of studies published before February 2019 was performed in PubMed, EMBASE, PsycINFO, CNKI and WANFANG DATA. Any quantitative study that measured Chinese adults' medicine beliefs using BMQ translations was included. Random-effects meta-analysis with 95% confidence interval (CI) was used to test the correlations between BMQ-Specific components (Necessity Belief or Concerns or their differential scores) and medication adherence. RESULTS Fifty-eight eligible articles (n = 12,595) were identified with sample sizes ranged from 48 to 967. Three meta-analyses (n = 17, 18 & 19) containing total 22 studies were performed. Adherence was significantly correlated with necessity beliefs (pooled correlation coefficient = 0.32, 95% CI: 0.21, 0.43), concerns (-0.35, 95% CI: -0.42, -0.28), and the necessity-concerns differential score (0.25, 95% CI: 0.15, 0.36). There was significant heterogeneity between studies for necessity beliefs (I2 = 93%, p < .001), concerns (I2 = 83%, p < .001) and differential score (I2 = 95%, p < .001). CONCLUSION The BMQ appears to be a reliable tool for assessing medication beliefs in the Chinese population. Chinese people's specific medicine beliefs about medicines were significantly correlated with medication adherence. The Necessity-Concerns Framework was suggested as a useful conceptual model to explain Chinese patients' medication adherence.
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Affiliation(s)
- Bo Nie
- Department of Practice and Policy, School of Pharmacy, University College London, London WC1H 9JP, UK.
| | - Sarah C E Chapman
- Department of Pharmacy and Pharmacology, University of Bath, Bath BA2 7AY, UK.
| | - Zhe Chen
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiuli Wang
- Department of Gynaecology, Xuzhou Hospital of Chinese Medicine, Xuzhou 221000, China
| | - Li Wei
- Department of Practice and Policy, School of Pharmacy, University College London, London WC1H 9JP, UK.
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22
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Brieger D, Amerena J, Attia J, Bajorek B, Chan KH, Connell C, Freedman B, Ferguson C, Hall T, Haqqani H, Hendriks J, Hespe C, Hung J, Kalman JM, Sanders P, Worthington J, Yan TD, Zwar N. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018. Heart Lung Circ 2019; 27:1209-1266. [PMID: 30077228 DOI: 10.1016/j.hlc.2018.06.1043] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - David Brieger
- Department of Cardiology, Concord Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
| | - John Amerena
- Geelong Cardiology Research Unit, University Hospital Geelong, Geelong, Australia
| | - John Attia
- University of Newcastle, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Beata Bajorek
- Graduate School of Health, University of Technology Sydney & Department of Pharmacy, Royal North Shore Hospital, Australia
| | - Kim H Chan
- Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Cia Connell
- The National Heart Foundation of Australia, Melbourne, Australia
| | - Ben Freedman
- Sydney Medical School, The University of Sydney, Sydney, Australia; Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Caleb Ferguson
- Western Sydney University, Western Sydney Local Health District, Blacktown Clinical and Research School, Blacktown Hospital, Sydney, Australia
| | | | - Haris Haqqani
- University of Queensland, Department of Cardiology, Prince Charles Hospital, Brisbane, Australia
| | - Jeroen Hendriks
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia; Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Charlotte Hespe
- General Practice and Primary Care Research, School of Medicine, The University of Notre Dame Australia, Sydney, Australia
| | - Joseph Hung
- Medical School, Sir Charles Gairdner Hospital Unit, University of Western Australia, Perth, Australia
| | - Jonathan M Kalman
- University of Melbourne, Director of Heart Rhythm Services, Royal Melbourne Hospital, Melbourne, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - John Worthington
- RPA Comprehensive Stroke Service, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Nicholas Zwar
- Graduate Medicine, University of Wollongong, Wollongong, Australia
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23
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Cai Q, Ye L, Horne R, Bi J, Xu Q, Ye X, Yang A, Jin M, Li X, Lv Q. Patients' adherence-related beliefs about inhaled steroids: application of the Chinese version of the Beliefs about Medicines Questionnaire-specific in patients with asthma. J Asthma 2019; 57:319-326. [PMID: 30663909 DOI: 10.1080/02770903.2019.1565824] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: The main objective of the present study is to evaluate the psychometric properties of the Chinese version of Beliefs about Medicines Questionnaire-specific among asthma patients; and to assess the association between patients' belief and adherence to inhaled corticosteroid therapy. Methods: A cross-sectional survey was carried out in the asthma clinic of Zhongshan Hospital, to Fudan University (Shanghai, China) between April 2016 and March 2018. The Beliefs about Medicines Questionnaire-specific was translated into Chinese according to international guidelines. Internal consistency, test-retest reliability, and confirmatory factor analysis were calculated to validate the Beliefs about Medicines Questionnaire-specific. The relationship between the adherence and the belief subscale were assessed using Kruskal-Wallis test. Results: Two hundred and seventeen patients were recruited in this study. The Beliefs about Medicines Questionnaire-specific was deemed reliable based on the results of Cronbach's alpha coefficient and test-retest intraclass correlation coefficient (ICC, ICC= 0.759). Confirmatory factor analysis showed acceptable model fit for the two-factor model. Patients' compliance was closely related to their belief about inhaled corticosteroid. The adherence rates were highest for the accepting groups, and lowest for the skeptical groups. Higher adherence was significantly associated with higher necessity-concerns differential (p = .001) and lower concern (p = .004). Conclusions: The Chinese version of the Beliefs about Medicines Questionnaire-specific can be used as a reliable tool by the clinicians to identify beliefs and behaviors of individual to improve adherence in Chinese patients.
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Affiliation(s)
- Qingqing Cai
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Ling Ye
- Department of Respiratory, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Robert Horne
- UCL School of Pharmacy, University College London, London, United Kingdom
| | - Jing Bi
- Department of Respiratory, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Qing Xu
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Xiaofen Ye
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Aifang Yang
- Department of Pharmacy, Worker's Medical Clinic, Macau, PR China
| | - Meiling Jin
- Department of Respiratory, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Xiaoyu Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, PR China
| | - Qianzhou Lv
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, PR China
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24
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Lowres N, Giskes K, Hespe C, Freedman B. Reducing Stroke Risk in Atrial Fibrillation: Adherence to Guidelines Has Improved, but Patient Persistence with Anticoagulant Therapy Remains Suboptimal. Korean Circ J 2019; 49:883-907. [PMID: 31535493 PMCID: PMC6753021 DOI: 10.4070/kcj.2019.0234] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/24/2022] Open
Abstract
Atrial fibrillation (AF) is a significant risk factor for avoidable stroke. Among high-risk patients with AF, stroke risk can be mitigated using oral anticoagulants (OACs), however reduction is largely contingent on physician prescription and patient persistence with OAC therapy. Over the past decade significant advances have occurred, with revisions to clinical practice guidelines relating to management of stroke risk in AF in several countries, and the introduction of non-vitamin K antagonist OACs (NOACs). This paper summarises the evolving body of research examining guideline-based clinician prescription over the past decade, and patient-level factors associated with OAC persistence. The review shows clinicians' management over the past decade has increasingly reflected guideline recommendations, with an increasing proportion of high-risk patients receiving OACs, driven by an upswing in NOACs. However, a treatment gap remains, as 25–35% of high-risk patients still do not receive OAC treatment, with great variation between countries. Reduction in stroke risk directly relates to level of OAC prescription and therapy persistence. Persistence and adherence to OAC thromboprophylaxis remains an ongoing issue, with 2-year persistence as low as 50%, again with wide variation between countries and practice settings. Multiple patient-level factors contribute to poor persistence, in addition to concerns about bleeding. Considered review of individual patient's factors and circumstances will assist clinicians to implement appropriate strategies to address poor persistence. This review highlights the interplay of both clinician's awareness of guideline recommendations and understanding of individual patient-level factors which impact adherence and persistence, which are required to reduce the incidence of preventable stroke attributable to AF.
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Affiliation(s)
- Nicole Lowres
- Heart Research Institute, Charles Perkins Centre, Camperdown, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Katrina Giskes
- Heart Research Institute, Charles Perkins Centre, Camperdown, Australia.,School of Medicine, The University of Notre Dame, Sydney, Australia
| | - Charlotte Hespe
- School of Medicine, The University of Notre Dame, Sydney, Australia
| | - Ben Freedman
- Heart Research Institute, Charles Perkins Centre, Camperdown, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Cardiology, Concord Hospital, The University of Sydney Concord Clinical School, Concord, Australia
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Jiang J, Ji N, Lan J, Ge X, Du X. Clinical verification of Lou type warfarin pharmacokinetic dosing algorithms equation. Mol Med Rep 2018; 17:6144-6149. [PMID: 29436624 DOI: 10.3892/mmr.2018.8562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 12/22/2017] [Indexed: 01/07/2023] Open
Abstract
Warfarin is the most commonly used oral anti-coagulant in clinic practice. However, it is difficult to recommend the correct dosage due to its narrow therapeutic window. The aim of the present study was to verify the clinical value of the Lou type equation, using pharmacogenetics‑based warfarin dosing algorithms to appropriately predict the actual maintenance dose. A total of 87 Chinese Han patients who required treatment with warfarin were enrolled and randomly divided into the experimental and control groups. In the experimental group, the first 3 doses of warfarin were calculated according to the Lou type equation. While in the control group, these 3 treatments were performed following the doctors' recommendations. Then the dose of warfarin was gradually adjusted to the stable dose according to the changes in the international standardized ratio. At the end of the 50 day experimental period, there were a greater number of patients in the experimental group who exhibited a stable blood concentration of warfarin than those in the control group (83.35 and 64.4%, respectively). In addition, the mean and median times for patients to obtain a stable dose in the experimental group were significantly shorter than those in the control group (mean, 18.2±1.7 and 27.3±2.0 days; and median, 11.7±1.1 and 20.5±1.8 days, respectively). The adverse reaction rate of the experimental group (9.5%) was markedly lower than that of the control group (26.7%). The occurrence of adverse reactions in the experimental group was also significantly later when compared with the control group (43.9±1.6 and 38.6±1.5 days, respectively). Furthermore, there was no significant difference between the average predicted dose (3.4±1.1 mg/day) and the average actual dose (3.5±1.4 mg/day; P=0.313). In conclusion, using the Lou type warfarin pharmacokinetic dosing algorithm equation to administer warfarin markedly shortened the adjustment time of warfarin to reach a stable dose and reduced the adverse reactions rate, thus supporting clinical feasibility.
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Affiliation(s)
- Jiangang Jiang
- Department of Cardiology, Jinhua Hospital of TCM Affiliated to Zhejiang University of Traditional Chinese Medicine, Jinhua, Zhejiang 321000, P.R. China
| | - Ningning Ji
- Department of Cardiology, Yiwu Central Hospital, Yiwu, Zhejiang 322000, P.R. China
| | - Jingliang Lan
- Department of Cardiology, Jinhua Hospital of TCM Affiliated to Zhejiang University of Traditional Chinese Medicine, Jinhua, Zhejiang 321000, P.R. China
| | - Xiaoping Ge
- Department of Geriatrics, Zhejiang Jinhua Guangfu Hospital, Jinhua, Zhejiang 321000, P.R. China
| | - Xiaoma Du
- Department of Cardiology, Jinhua Hospital of TCM Affiliated to Zhejiang University of Traditional Chinese Medicine, Jinhua, Zhejiang 321000, P.R. China
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26
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Zweiker D, Zweiker R, Winkler E, Roesch K, Schumacher M, Stepan V, Krippl P, Bauer N, Heine M, Reicht G, Zweiker G, Sprenger M, Watzinger N. Association between subjective risk perception and objective risk estimation in patients with atrial fibrillation: a cross-sectional study. BMJ Open 2017; 7:e018242. [PMID: 28951417 PMCID: PMC5623506 DOI: 10.1136/bmjopen-2017-018242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Oral anticoagulation (OAC) is state-of-the-art therapy for atrial fibrillation (AF), the most common arrhythmia worldwide. However, little is known about the perception of patients with AF and how it correlates with risk scores used by their physicians. Therefore, we correlated patients' estimates of their own stroke and bleeding risk with the objectively predicted individual risk using CHA2DS2-VASc and HAS-BLED scores. DESIGN Cross-sectional prevalence study using convenience sampling and telephone follow-up. SETTINGS Eight hospital departments and one general practitioner in Austria. Patients' perception of stroke and bleeding risk was opposed to commonly used risk scoring. PARTICIPANTS Patients with newly diagnosed AF and indication for anticoagulation. MAIN OUTCOME MEASURES Comparison of subjective risk perception with CHA2DS2-VASc and HAS-BLED scores showing possible discrepancies between subjective and objective risk estimation. Patients' judgement of their own knowledge on AF and education were also correlated with accuracy of subjective risk appraisal. RESULTS Ninety-one patients (age 73±11 years, 45% female) were included in this study. Subjective stroke and bleeding risk estimation did not correlate with risk scores (ρ=0.08 and ρ=0.17). The majority of patients (57%) underestimated the individual stroke risk. Patients feared stroke more than bleeding (67% vs 10%). There was no relationship between accurate perception of stroke and bleeding risks and education level. However, we found a correlation between the patients' judgement of their own knowledge of AF and correct assessment of individual stroke risk (ρ=0.24, p=0.02). During follow-up, patients experienced the following events: death (n=5), stroke (n=2), bleeding (n=1). OAC discontinuation rate despite indication was 3%. CONCLUSIONS In this cross-sectional analysis of OAC-naive patients with AF, we found major differences between patients' perceptions and physicians' assessments of risks and benefits of OAC. To ensure shared decision-making and informed consent, more attention should be given to evidence-based and useful communication strategies. TRIAL REGISTRATION NUMBER NCT03061123.
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Affiliation(s)
- David Zweiker
- Division of Cardiology, Department of Internal Medicine, Medizinische University Graz, Graz, Steiermark, Austria
| | - Robert Zweiker
- Division of Cardiology, Department of Internal Medicine, Medizinische University Graz, Graz, Steiermark, Austria
| | - Elisabeth Winkler
- Division of Cardiology, Department of Internal Medicine, Medizinische University Graz, Graz, Steiermark, Austria
| | - Konstantina Roesch
- Division of Cardiology, Department of Internal Medicine, Medizinische University Graz, Graz, Steiermark, Austria
| | - Martin Schumacher
- Department of Internal Medicine, Hospital Barmherzige Brueder Marschallgasse, Graz, Steiermark, Austria
| | - Vinzenz Stepan
- Department of Internal Medicine, Hospital Elisabethinen, Graz, Austria
| | - Peter Krippl
- Department of Internal Medicine, LKH Fürstenfeld, Krankenhausverbund Feldbach, Fürstenfeld, Austria
| | - Norbert Bauer
- Department of Internal Medicine, LKH Hartberg, Steiermark, Austria
| | - Martin Heine
- Department of Neurology, LKH Feldbach, Krankenhausverbund Feldbach-Fürstenfeld, Feldbach, Steiermark, Austria
| | - Gerhard Reicht
- Department of Internal Medicine, Krankenhaus Barmherzige Bruder Graz-Eggenberg, Graz, Steiermark, Austria
| | - Gudrun Zweiker
- General Practitioner Dr. Gudrun Zweiker, Straden, Austria
| | - Martin Sprenger
- Department of Social Medicine and Epidemiology, Medical University of Graz, Steiermark, Austria
| | - Norbert Watzinger
- Department of Internal Medicine, Landeskrankenhaus Feldbach, Feldbach, Steiermark, Austria
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