November 10, 2015Canadian Journal of Cardiology113 citationsOpen Access
Values and Preferences of Physicians and Patients With Nonvalvular Atrial Fibrillation Who Receive Oral Anticoagulation Therapy for Stroke Prevention
Structured PICO
What are the values, preferences, and experiences of patients and physicians regarding oral anticoagulation therapy for stroke prevention in nonvalvular atrial fibrillation?
P
Population
Randomly selected patients with nonvalvular atrial fibrillation receiving oral anticoagulation therapy (n=266) and physicians prescribing oral anticoagulation therapy (n=178).
I
Intervention
Oral anticoagulant therapy (apixaban, rivaroxaban, warfarin)
O
Outcome
Values, preferences, and experience regarding oral anticoagulant therapy attributespatient reported
Real-world OAC prescribing patterns do not align with physician preferences based on blinded medication attributes, and patient adherence is significantly better with once-daily dosing regimens.
Abstract
BACKGROUND: Real-world data on patients' and physicians' values related to the use of oral anticoagulant (OAC) therapy for stroke prevention in patients with nonvalvular atrial fibrillation are currently lacking. We sought to assess the values, preferences, and experience of patients who receive OAC therapy, and of physicians who prescribe OAC therapy. METHODS: A national survey of randomly selected patients (n = 266) and physicians (n = 178) was conducted between May and September 2014. Each was asked to evaluate the importance of individual OAC attributes and identify which of 2 medication profiles they would prefer (individual attributes were progressively modified to determine which were the most valued and/or influenced treatment choice). Medication adherence and prescription practice was also assessed. RESULTS: The preferences of patients and physicians regarding OAC therapy differed but largely focused on characteristics related to safety and, to a lesser extent, efficacy. When based solely on the basis of the attribute profile (blinded to the specific agent), physicians were more likely to select apixaban (61%), whereas patients showed no significant preference among apixaban, rivaroxaban, and warfarin. Despite this, 49% of physicians spontaneously stated rivaroxaban as their preferred agent (vs 25% apixaban). Patients prescribed and taking once daily medications (rivaroxaban or warfarin) showed better compliance with their OAC therapy (approximately 30% of twice daily medications being taken once daily, with significantly more missed doses compared with once daily medications). CONCLUSIONS: Real-world prescriptions do not reflect reported values, which suggests that other factors influence patient-physician decision-making around OAC therapy. Data on self-reported adherence to OAC therapy and discordance in the use of OACs from prescribed regimens are concerning and warrant further investigation.