Impact of Switching From a Vitamin K Antagonist to Rivaroxaban on Satisfaction With Anticoagulation Therapy: The XANTUS‐ACTS Substudy

Abstract

BackgroundThe efficacy, safety, and ease of use of rivaroxaban may reduce anticoagulation‐treatment burden and improve nonvalvular atrial fibrillation (NVAF) patient satisfaction compared with vitamin K antagonists (VKAs).HypothesisTransitioning from a VKA to rivaroxaban improves treatment satisfaction in routine practice.MethodsXarelto for Prevention of Stroke in Patients With Atrial Fibrillation (XANTUS) is a prospective, noninterventional study in patients with NVAF prescribed rivaroxaban for prevention of stroke in routine practice. Patients receiving a VKA 4 weeks prior to the initial XANTUS study visit and switched to rivaroxaban were asked to complete the Anti‐Clot Treatment Scale (ACTS). Changes from the initial visit to the first follow‐up visit at ∼ 3 months (corresponding to a comparison of rivaroxaban vs prior VKA) for ACTS burden and benefit scores were calculated using and reported as least squared mean differences (LSMDs) with 95% confidence intervals (CIs).ResultsThe study included 1291 NVAF patients with prior VKA treatment. The mean baseline ACTS burden and benefit scores were 50.51 ± 8.42 and 10.30 ± 2.70, respectively. After ∼ 3 months of rivaroxaban treatment, LSMDs were 4.38 points (95% CI: 2.53‐6.22, P < 0.0001) for the burden and 1.01 points (95% CI: 0.27‐1.75, P = 0.0075) for the benefit score. Fifty‐four percent and 48% of patients reported experiencing at least a minimally important clinical difference in burden and benefit scores, respectively.ConclusionsWithin this XANTUS cohort, switching from a VKA to rivaroxaban yielded statistically and clinically significant improvements in ACT burden and benefit scores.

Patient Satisfaction with Direct Oral Anticoagulants and Warfarin

“…Patient satisfaction over time: The greater satisfaction reflected in the DOAC patients' ACTS burdens scores did not change during the mean follow-up period of 11.8 months. These results were consistent with the follow-up results of other observational studies conducted in nonvaluvular AF patients 20,21) and of the EINSTEIN-DVT/PE studies, 13,14) but as noted, we did not find any difference in terms of the ACTS benefits scores. Our results together with other prior reports may, in part, support reproducibility or reliability of the ACTS scores for the patient satisfaction assessment in Japanese AF patients given anticoagulant drugs.…”

“…This result is consistent with those previously reported in AF patients. 20,21) In the two previously reported observational studies, switching from a VKA to rivaroxaban resulted in statistically and clinically significant improvements in the ACTS burdens and benefits scores. Limitations: Studies based on a real-world patient regis-PATIENT SATISFACTION AND ORAL ANTICOAGULANTS try have several limitations.…”

Physical, cognitive, and psychosocial conditions in relation to anticoagulation satisfaction among elderly adults with atrial fibrillation: The SAGE‐AF study

“…Anticoagulation satisfaction is an important patient‐reported outcome because it is strongly associated with anticoagulation adherence and clinical outcomes, including bleeding and stroke . The previous literature on anticoagulation satisfaction in AF has generally focused on comparing satisfaction among warfarin‐treated patients to those treated with DOACs in whom the burden from anticoagulation treatment is generally lower . Patient perceptions of the burdens and benefits of anticoagulation are important in the context of AF management, since treatment is generally life‐long, often requires behavior change (ie, change in diet), and is associated with potential harm.…”

“…[24][25][26] The previous literature on anticoagulation satisfaction in AF has generally focused on comparing satisfaction among warfarin-treated patients to those treated with DOACs in whom the burden from anticoagulation treatment is generally lower. 3,27 Patient perceptions of the burdens and benefits of anticoagulation are important in the context of AF management, since treatment is generally life-long, often requires behavior change (ie, change in diet), and is associated with potential harm. In addition to their associations with clinical outcomes, assessment of patient beliefs and preferences surrounding anticoagulation is a critical component of anticoagulation shared decision making, a process endorsed for providers and patients by the 2016 American College of Cardiology AF Quality Guidelines.…”

Translation, Cultural Adaptation, and Psychometric Properties of the Danish Version of the Anti-Clot Treatment Scale

“…The ACTS is used in many recent and ongoing international studies and registries for the evaluation of treatment satisfaction, 10 11 12 13 also allowing comparison between different oral anticoagulants. The questionnaire can, however, only be used in countries where a translation in the national language is available.…”