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

Abstract

Background and aimsAtrial fibrillation (AF) is the most common arrhythmia in elderly people, yet oral anticoagulation is underused in the aged. We tried to determine whether new oral anticoagulants (NOA) have greater psychological tolerability than warfarin.MethodsAge-, gender-matched groups of AF patients receiving NOA (N = 15) or warfarin (N = 15) were assessed with the Anti-Clot Treatment Scale (ACTS) and the Perceived Stress Scale (PSS).ResultsPatients were old (81 ± 9 years). NOA group showed greater psychological satisfaction, with lower therapy-related burden (ACTS burdens: 16.3 ± 4.5 vs. 32.9 ± 10.2, p < 0.001) and higher awareness of benefits (ACTS benefits: 13.0 ± 1.3 vs. 10.8 ± 1.9, p = 0.001). Even stress was lower (PSS: 13.1 ± 4.0 vs. 17.1 ± 4.2, p = 0.013). The multivariate analysis confirmed these findings, showing that higher levels of anxiety and depression could justify more stress in warfarin patients.ConclusionsThe results of this preliminary study show that NOA have an improved psychological impact compared with warfarin in elderly patients.

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

“…11 -13 In a study performed by Fumagalli and colleagues 11 comparing age-and sex-matched AF patients receiving either a NOAC (n = 15) or warfarin (n = 15), NOAC patients reported less therapy burden (ACTS burden score [not reversed scored]: 16.3 ± 4.5 vs 32.9 ± 10.2; P < 0.001) and greater perception of benefit than VKA patients (ACTS benefit score: 13.0 ± 1.3 vs 10.8 ± 1.9; P = 0.001). The NOAC users also reported less stress in this study as measured by the Perceived Stress Scale (13.1 ± 4.0 vs 17.1 ± 4.2; P = 0.013).…”

“…Two main strengths of this analysis were its use of prospectively collected data and its relatively large sample size compared with prior ACTS evaluations in AF patients. 11,12,18 As for limitations, it is important to note that XANTUS was a single-arm registry study. 8 This meant our rivaroxaban vs warfarin comparison had to be performed as a before-and-after analysis.…”

Oral anticoagulant therapy for older patients with atrial fibrillation: a review of current evidence

“…However, also VKA therapy is challenging in these patients, and its potential benefit appears to be strictly dependent on the possibility of ensuring an adequate TTR [1,3,11]. The evidence on safety and the lack of need for routine coagulation monitoring, along with some evidence that DOACs may have greater psychological tolerability in elderly patients [105] make DOACs particularly attractive, and should hopefully widen the treatment options also for frail individuals, thereby allowing a greater number of patients to be treated according to current recommendations. In accord with these considerations, since DOACs were approved, it has been reported an increased number of newly diagnosed AF patients -including older subjects -properly treated with OAT; this was predominantly driven by an increased use of DOACs and reduced use of VKAs and/or antiplatelet therapy [106].…”

Preferences for anticoagulation therapy in atrial fibrillation: the patients’ view

“…However, VKAs do have well-known weaknesses, including necessary dosing adjustments in conjunction with regular INR value monitoring, drug/food interactions or the need of periprocedural interruption (bridging), which may be associated with a substantial burden to patients [14]. That may also be one of the explanations for the high percentage of patients still not treated by OAC despite its well-known benefits [15][16][17].…”

“…However, former studies indicate that there may exist a difference in patient perception with regard to the mentioned treatment options [14,21,22]. This is of particular importance because, inherently, every treatment should be centred on the patient.…”