Attitudes toward anticoagulant treatment among nonvalvular atrial fibrillation patients at high risk of stroke and low risk of bleed

Abstract

BackgroundAtrial fibrillation (AF) is associated with an increased risk of stroke. Anticoagulant (AC) therapies are effective at treating AF, but carry with them an increased risk of bleed. Research suggests that a large proportion of AF patients who have high risk of stroke and low risk of bleeding are not currently receiving AC treatment. The goal of this study was to understand the reasons why these patients do not engage in this potentially life-saving treatment.MethodThrough a self-report online survey, using validated instruments, 1,184 US adults who self-reported a diagnosis of AF were screened for the risk of stroke and bleed. Of these patients, 230 (19.4%) were at high risk of stroke, low risk of bleed, and not currently using an AC treatment, and were asked follow-up questions to assess their reasons for nontreatment, attitudes toward treatment, and attitudes toward dosing regimens.ResultsThe most common reasons patients stopped AC treatment were concerns regarding bleeding (27.8%) and other medical concerns (26.6%), whereas the most common reason cited for not being prescribed an AC in the first place was the use of antiplatelet therapy as an alternative (57.1%). In both cases, potentially erroneous decisions regarding perceived stoke and/or bleeding risk were also a factor. Finally, the largest factors regarding attitudes toward treatment and dosing regimen were instructions from an authority figure (eg, physician, pharmacist) and ease of use, respectively.ConclusionResults suggest that many AF patients who are at high risk of stroke but at low risk of bleed may not be receiving AC due to potentially inaccurate beliefs about risk. This study also found that AF patients place trust in physicians above other factors such as cost when making treatment decisions. Increased education of patients by physicians on the risks and benefits may be a simple strategy to improve outcomes.

Patients’ Attitudes Towards Atrial Fibrillation in Al-Nasiriyah City

“…While patients aged between 60 and 69 years constituted 25 (27.8%) of the study sample. This result is different from the result of a study in which 28.7% of patients were between the ages of (65-and 69) years (Crivera et al, 2016). Our results differ from the results of a previous study which stated that about (50 %) of the participants were aged ≥ 60 years, and the Mean of their age was 56.2∓ 10.3 (Xu et al, 2010).…”

“…Concerning gender, the female got the highest participation rate (51%) than the males". This is consistent with the result of a study in which the female participants were more than the male 55.7% (Crivera et al, 2016). Contraindicated the result of a study in which the male participants were (53.4% of) the study sample (Janion-Sadowska et al, 2019).…”

Patients’ and clinicians’ perceptions of oral anticoagulants in atrial fibrillation: a systematic narrative review and meta-analysis

“…These concerns did not appear to fade with the introduction of DOACs as two studies reported doctors under-prescribing DOACs for fear of causing bleeds [ 32 , 41 ]. Furthermore, the complexities and burden of therapy in elderly patients who often have co-morbidities as well as impaired cognitive and functional ability further contribute to concerns about medication safety [ 31 , 45 , 46 ].…”

“…Finally, the impact of patient’s beliefs on adherence was identified in some studies and this influenced decisions about treatment such as adherence and necessity of medication [ 31 , 38 ]. Two studies highlighted issues surrounding patients’ misconception of atrial fibrillation and poor understanding of the aims of anticoagulant treatment.…”

The effect of focal cerebral ischemia-reperfusion injury on TLR4 and NF-κB signaling pathway

“…Reperfusion after cerebral ischemia sometimes does not only restore the normal brain function, but also aggravates tissue damage and dysfunction, which is called cerebral ischemia-reperfusion injury. Due to the compensation of human body, the damage caused by reperfusion only occurs on one side, that is, focal ischemia-reperfusion injury ( 7 – 9 ). Evidence showed that inflammation is closely related to the death of neuronal cells and causes neurological deficits, in which nuclear transcription factor-κB (NF-κB) is one of the key genes that cause inflammation ( 10 ).…”