Effect of targeted education for atrial fibrillation patients: Design of the EduCare‐AF Study

Delesie, Michiel; Knaepen, L; Dendale, Paul; Vijgen, Johan; Ector, Joris; Verbeeck, Johan; Bruyndonckx, Robin; Desteghe, Lien; Heidbüchel, Hein

doi:10.1111/eci.13442

Cited by 7 publications

(12 citation statements)

References 14 publications

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“…Our finding that patients with dementia were less likely to be prescribed an OAC is consistent with a recent study by Madhavan et al, using the data from ORBIT, 32 and a meta‐analysis by Fanning et al 33 One possible reason for less frequent OAC prescribing is GPs’ perception of low efficacy and high risk of bleeding due to increased chance of inappropriate self‐anticoagulation in patients with cognitive impairment 34 . Tailored education for patients with early dementia or their careers instead of not prescribing OAC might be a better alternative 35 …”

Section: Discussionsupporting

confidence: 80%

“…34 Tailored education for patients with early dementia or their careers instead of not prescribing OAC might be a better alternative. 35 From 2016 onwards, apixaban was the most commonly initiated DOAC and overtook dabigatran in 2014 and rivaroxaban in 2016. A study by Rose et al 36 from the United States reported similar patterns in which apixaban use overtook rivaroxaban and dabigatran in 2015.…”

Section: Discussionmentioning

confidence: 99%

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Factors influencing oral anticoagulant use in patients newly diagnosed with atrial fibrillation

Bezabhe

Bereznicki

Radford

et al. 2020

Eur J Clin Investigation

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Background: We investigated factors that influenced oral anticoagulant (OAC) initiation and choice in Australian general practice patients newly diagnosed with AF. Methods: Using an Australian nationally representative general practice dataset, MedicineInsight, we identified patients newly diagnosed with AF between January 2009 and April 2019. Logistic regression analyses were used to examine factors associated with OAC initiation and choice. Results: A total of 63 212 patients with AF (53.7% males, mean age 72.4 years) were identified. Nearly two-thirds of these patients (40 854 [64.6%]) were initiated on an OAC, at a median time of 6 days after the documented diagnosis date. The proportion of patients who were initiated an OAC increased from 44.8% in 2009 to 72.2% in 2019 (P < .001). High risk of stroke (CHA 2 DS 2 -VASc, adjusted odds ratio (AOR), 4.39 [95% CI, 3.99-4.83]), low risk of bleeding (ORBIT, AOR, 1.87 [95% CI, 1.72-2.03]), not having a recorded history of dementia (AOR, 1.81 [95% CI, 1.65-1.98]) and male sex (AOR, 1.29 [95% CI, 1.22-1.35]) were independently associated with OAC initiation. Direct-acting oral anticoagulant (DOAC) use increased from 11.9% in 2011 to 94.0% of all OAC initiations in April 2019 (P < .001). Conclusions: The proportion of newly diagnosed patients with AF initiated on OAC increased markedly following the introduction of the DOACs. Of those initiated, 9 in 10 were receiving a DOAC at the end of the study period. There is potential underuse in women and individuals with dementia. K E Y W O R D S atrial fibrillation, oral anticoagulant, oral anticoagulant choice, oral anticoagulant initiation, primary care How to cite this article: Bezabhe WM, Bereznicki LR, Radford J, et al. Factors influencing oral anticoagulant use in patients newly diagnosed with atrial fibrillation.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Factors influencing oral anticoagulant use in patients newly diagnosed with atrial fibrillation

Bezabhe

Bereznicki

Radford

et al. 2020

Eur J Clin Investigation

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“…[ 30 ] Intensive targeted education and AF monitoring may improve anticoagulation status. [ 31 ] However, if selected AF patients can discontinue OACs safely, it would facilitate the management of atrial fibrillation. The evidence evaluating this topic was limited to observational studies and this meta-analysis aimed to determine how to balance the risk of thromboembolism and major bleeding.…”

Section: Discussionmentioning

confidence: 99%

It can be safe to discontinue oral anticoagulants after successful atrial fibrillation ablation: A systematic review and meta-analysis of cohort studies

Wang,

Li,

Wang

et al. 2023

Medicine

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Background: Current guidelines recommended that oral anticoagulants (OACs) should last for a minimum first 2 months after atrial fibrillation (AF) ablation and the long-term decision of anticoagulation after AF ablation should be based on the individual patient’s risk of stroke rather than the rhythm status. There is controversy about the safety of discontinuing OACs in patients with atrial fibrillation after the blanking period due to the divergences between consensus recommendations and clinical practice. Methods: Electronic bibliographic sources (PubMed, Embase, and Web of Science) were searched until August 2023 to identify cohort studies about the safety of discontinuing OACs in patients with AF after the blanking period. The primary outcome was thromboembolism (TE). The secondary outcome was major bleeding events (MBEs). Two authors extracted articles independently using predefined data fields. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated based on a random-effects model. Results: A total of 16 studies (11 prospective cohorts and 5 retrospective cohorts) enrolling 23,942 patients (14,382 OFF-OAC and 9560 ON-OAC) were included in our analysis. No significant difference emerged in the risk of TE between OFF-OAC and ON-OAC patients following AF ablation after the banking period (OR = 0.66; 95%CI, 0.43–1.01). Similar results emerged in the patients with a high risk of TE after stratification by the risk level of TE (OR = 0.72; 95%CI, 0.25–2.08). A significant reduction in incidences of major bleeding was found in the OFF-OAC patients compared with the ON-OAC patients (OR = 0.23; 95%CI, 0.12–0.42). Subgroup analyses for TE found a reduction of incidences in the subgroups who switched to antiplatelet drugs and with a follow-up duration <3 years. Subgroup analyses for MBEs found a significant reduction of incidences in all subgroups. Conclusions: Our study suggests it can be safe to discontinue OACs after successful AF ablation. Discontinuation of OACs may reduce the risk of MBEs while not increasing the risk of TE.

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Section: Introductionmentioning

confidence: 99%

“…reinforced in-person or online education, patient involvement to improve self-care capabilities and telemonitoring for therapy adherence to OAC), to study the impact on clinical outcomes. 15 In order to actively involve patients in the different aspects of their treatment and connect them to their caregivers, there is an urgent need for new strategies. The rise in smartphone and tablet use creates opportunities to develop new digital strategies.…”

Section: Introductionmentioning

confidence: 99%

A new smartphone application for integrated transmural care of atrial fibrillation, AF-EduApp: Usability and validation study

et al. 2021

Self Cite

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Introduction Digital technology creates the opportunity to develop and evaluate new tools, such as smartphone applications, to support integrated atrial fibrillation management. This study aimed to develop, evaluate, and validate a new, integrated care application (AF-EduApp) mainly focusing on targeted atrial fibrillation education to improve patient self-care capabilities and therapy adherence. Methods The newly developed AF-EduApp, available for Android and iOS, consists of six different modules. The prototype was validated and optimized for its usability and functionality at Jessa Hospital Hasselt and Antwerp University Hospital in two phases: (1) validity evaluation with interviews of an expert panel with 15 healthcare professionals and 10 atrial fibrillation patients, and (2) a pilot study of 1 month with 20 atrial fibrillation patients. Results Both experts and patients found that the application aids atrial fibrillation management. Based on the input of patients and experts, the main optimizations concerned the medication module (patient choice on setting reminder; interactivity of reminders with a “taken” or “snooze” function) and development of a clinical dashboard for the caregivers allowing telemonitoring of measurements and feedback to the patients. After the pilot study ( n = 20), 16 patients indicated they wanted to use the app for a longer period. The measurement (27%) and education (17%) modules were the two most used modules with a significant improvement in knowledge (71.9% to 87.5%; P = 0.013). Discussion The AF-EduApp received a positive evaluation from health professionals and atrial fibrillation patients. Further development should be focused on the medication module and improvement of the clinical dashboard.

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Effect of targeted education for atrial fibrillation patients: Design of the EduCare‐AF Study

Cited by 7 publications

References 14 publications

Factors influencing oral anticoagulant use in patients newly diagnosed with atrial fibrillation

Factors influencing oral anticoagulant use in patients newly diagnosed with atrial fibrillation

It can be safe to discontinue oral anticoagulants after successful atrial fibrillation ablation: A systematic review and meta-analysis of cohort studies

A new smartphone application for integrated transmural care of atrial fibrillation, AF-EduApp: Usability and validation study

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