What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Atrial fibrillation (n=30). Intervention: New oral anticoagulants vs. Warfarin. Primary outcome: Therapy-related psychological burden (ACTS burdens score) (p=<0.001).

What question did this study set out to answer?

To evaluate whether new oral anticoagulants provide greater psychological tolerability and reduced treatment-related burden compared to warfarin in elderly individuals with atrial fibrillation.

May 31, 2014Aging Clinical and Experimental ResearchOpen Access

Psychological effects of treatment with new oral anticoagulants in elderly patients with atrial fibrillation: a preliminary report

Q: What are the key findings of this study?

New oral anticoagulants were associated with significantly lower therapy-related psychological burden (ACTS burden score 16.3 vs 32.9, p<0.001) compared to warfarin in elderly patients with atrial fibrillation.

Q: What question did this study set out to answer?

To evaluate whether new oral anticoagulants provide greater psychological tolerability and reduced treatment-related burden compared to warfarin in elderly individuals with atrial fibrillation.

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Key result

New oral anticoagulants were associated with significantly lower therapy-related psychological burden (ACTS burden score 16.3 vs 32.9, p<0.001) compared to warfarin in elderly patients with atrial fibrillation.

Why the study?

Does treatment with new oral anticoagulants improve psychological satisfaction and reduce stress compared to warfarin in elderly patients with atrial fibrillation?

Population

30 elderly patients with atrial fibrillation or history of AF, single-center in Italy. Key exclusions…

Comparison

New oral anticoagulants - specifically… vs Warfarin (age- and gender-matched cohort).

Design

Cohort

Follow-up

at least 4 weeks (modal duration 4 months)

Authors

SFStefano FumagalliUniversity of Modena and Reggio Emilia FCFrancesca CardiniAzienda Unità Sanitaria Locale Della Romagna ARAnna Teresa RobertsUniversity of Pittsburgh

Discussion

Member takes

Implication

May reduce psychological burden in elderly AF patients on NOACs; leaves open confirmation of adherence or outcome benefits in RCTs.

Key Points

To evaluate whether new oral anticoagulants provide greater psychological tolerability and reduced treatment-related burden compared to warfarin in elderly individuals with atrial fibrillation.
Assessed age- and gender-matched groups of elderly atrial fibrillation patients receiving either new oral anticoagulants (N = 15) or warfarin (N = 15), with an overall mean age of 81 ± 9 years.
Measured psychological burden and satisfaction with the Anti-Clot Treatment Scale (ACTS) and stress levels using the Perceived Stress Scale (PSS), evaluated alongside multivariate analysis for anxiety and depression.
Patients receiving new oral anticoagulants reported significantly lower treatment burden (ACTS burden: 16.3 ± 4.5 vs. 32.9 ± 10.2, p < 0.001) and greater awareness of treatment benefits (ACTS benefits: 13.0 ± 1.3 vs. 10.8 ± 1.9, p = 0.001).
Perceived stress was significantly lower in the new oral anticoagulant cohort compared to warfarin (PSS: 13.1 ± 4.0 vs. 17.1 ± 4.2, p = 0.013), with multivariate analysis indicating that elevated anxiety and depression accounted for higher stress among warfarin users.

Study Design

Type

Cross-Sectional (n=30)

Multicenter

Structured PICO

Does treatment with new oral anticoagulants improve psychological satisfaction and reduce stress compared to warfarin in elderly patients with atrial fibrillation?

Population

30 elderly patients with atrial fibrillation (mean age 81 years, 33% female) treated with either new oral anticoagulants or warfarin for at least 4 weeks.

Exposure

New oral anticoagulants (NOA) - specifically dabigatran (n=14) and rivaroxaban (n=1) - administered for at least 4 weeks.

Comparator

Warfarin (age- and gender-matched cohort).

Outcome

Psychological tolerability and satisfaction assessed by the Anti-Clot Treatment Scale (ACTS) and Perceived Stress Scale (PSS) after at least 4 weeks of treatment.patient reported

Main Result

Absolute Event Rate: 16.3% vs 32.9%

p-value: p=<0.001

New oral anticoagulants are associated with significantly lower therapy-related burden and perceived stress compared to warfarin in elderly patients with atrial fibrillation.

Limitations

Small sample size
Some warfarin patients had received external cardioversion in the past, which could cause psychological discomfort
Some NOA patients had already received warfarin in the past
All NOA patients in the final analysis received dabigatran, lacking data on rivaroxaban or apixaban
Some warfarin patients had received external cardioversion in the past
All NOA patients received dabigatran (except one), lacking data on rivaroxaban or apixaban

Cite This Study

Fumagalli et al. (2014) conducted a cross-sectional in Atrial fibrillation (n=30). New oral anticoagulants vs. Warfarin was evaluated on Therapy-related psychological burden (ACTS burdens score) (p=<0.001). New oral anticoagulants were associated with significantly lower therapy-related psychological burden (ACTS burden score 16.3 vs 32.9, p<0.001) compared to warfarin in elderly patients with atrial fibrillation.

synapsesocial.com/papers/6a9ed9ac0fc97ef28e11f8b1 https://doi.org/10.1007/s40520-014-0243-x

Topics

Atrial fibrillation Persistent AF management Anticoagulation in AF

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Psychological effects of treatment with new oral anticoagulants in elderly patients with atrial fibrillation: a preliminary report

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Psychological effects of treatment with new oral anticoagulants in elderly patients with atrial fibrillation: a preliminary report

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider