Key result
A questionnaire-based score identified patient preferences for oral anticoagulants, predicting recommendations to maintain or change therapy with c-statistics of 0.71 to 0.83 (p<0.0347).
Why the study?
Can a questionnaire-based score identify patient preferences to guide the continuation or change of oral anticoagulant therapy?
Observational (n=1,004)
Can a questionnaire-based score identify patient preferences to guide the continuation or change of oral anticoagulant therapy?
Effect estimate: c-statistic 0.83 (groups 1 vs 2) and 0.71 (groups 1 vs 3)
p-value: p=0.0347 to <0.0001
A newly developed questionnaire-based score can effectively identify patient preferences to guide shared decision-making regarding the choice between VKA and NOAC therapy.
May support preference-aligned OAC decisions; leaves open prospective validation for adherence or outcome benefits.
Patients with indication for anticoagulation may prefer treatment with a vitamin K antagonist (VKA) or non-vitamin K antagonist oral anticoagulant (NOAC). A questionnaire may help to identify the preference of patients for one of the two types of oral anticoagulants and to develop a score for the recommendation to continue or to change the anticoagulant. A score was developed using a questionnaire containing biographic data and eight statements on attitudes on anticoagulation and was derived to trigger continuation or change the type of anticoagulant by defining ranges of terms and weighting of the significant statements identified by logistic regression analysis. Participating patients received either anticoagulation with VKA (group 1, n = 690), were transferred from VKA to NOAC (group 2, n = 158), received NOAC de novo (group 3, n = 137) or were transferred from NOAC to VKA (group 4, n = 19). Four statements were significantly (p values between 0.0347 and < 0.0001) associated with recommendations to maintain or to change the type of anticoagulant for patients in groups 1, 2, or 3 with predictive values of c = 0.83 between groups 1 and 2 and c = 0.71 between groups 1 and 3. From the total number of replies to the statements a score of three grades and two strengths (A = strong, B = moderate) was derived for the recommendations. This tool supports recommendations as to continue or to change the presently used type of oral anticoagulant based on the identification of patients' preferences.
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Zolfaghari et al. (2015) conducted an observational in Indication for anticoagulation (n=1,004). Questionnaire-based preference score was evaluated on Association of questionnaire statements with recommendations to maintain or change the type of anticoagulant (c-statistic 0.83 (groups 1 vs 2) and 0.71 (groups 1 vs 3), p=0.0347 to <0.0001). A questionnaire-based score identified patient preferences for oral anticoagulants, predicting recommendations to maintain or change therapy with c-statistics of 0.71 to 0.83 (p<0.0347).
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