Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2018 Jun;41(6):855-861.
doi: 10.1002/clc.22971. Epub 2018 Jun 12.

Atrial fibrillation patient preferences for oral anticoagulation and stroke knowledge: Results of a conjoint analysis

Deirdre A Lane  1 , Juliane Meyerhoff  2 , Ute Rohner  3 , Gregory Y H Lip  1
Affiliations
Multicenter Study

Atrial fibrillation patient preferences for oral anticoagulation and stroke knowledge: Results of a conjoint analysis

Deirdre A Lane et al. Clin Cardiol. 2018 Jun.

Abstract

Background: Guidelines recommend that patients with atrial fibrillation (AF) are involved in oral anticoagulant (OAC) treatment decisions. Understanding which OAC attributes AF patients value most could help optimize treatment.

Objective: To assess the relationship between patient's stroke knowledge and their preferences for specific OAC attributes.

Methods: A cross-sectional online survey was conducted in patients with nonvalvular AF taking an OAC for stroke prevention in the United States, Canada, Germany, France, and Japan. Patients were asked about their stroke knowledge, perception of the seriousness of AF and concern about stroke, and to rank 7 OAC attributes in order of importance. A conjoint analysis was performed to determine the inherent value of 4 attributes.

Results: In total, 937 patients (mean age [standard deviation] 54.3 [16.6] years; 37.1% female) participated. Of these, 19.5%, 27.9%, and 29.8% had good, moderate, and low stroke knowledge, respectively; 22.8% had no stroke knowledge. Overall, 39.4% of patients (47.5% with good stroke knowledge) perceived AF as very/extremely serious. The OAC attribute ranked as most important was stroke prevention followed by major bleeding risk, other side effects, dosing frequency, antidote availability, dietary restrictions, and use with/without food. In the conjoint analysis, stroke risk reduction was the most valued property, followed by reduction in major bleeding risk, less frequent administration, and administration with/without food. Preferences did not differ with level of stroke knowledge, perception of seriousness of AF, concern of stroke, or medication burden.

Conclusions: Most AF patients consider efficacy and safety to be the most important OAC attributes, whereas dosing frequency was deemed as less important.

Keywords: Atrial Fibrillation; Conjoint Analysis; Oral Anticoagulants; Patient Preference; Stroke Knowledge.

PubMed Disclaimer

Conflict of interest statement

D.A. Lane has received investigator‐initiated educational grants from Bristol‐Myers Squibb and Boehringer Ingelheim, has been a speaker for Boehringer Ingelheim, Bayer, and Bristol‐Myers Squibb/Pfizer, and has consulted for Bristol‐Myers Squibb/Pfizer, Bayer, and Boehringer Ingelheim. J. Meyerhoff and U. Rohner are employees of Boehringer Ingelheim. G.Y.H. Lip has been a consultant for Bayer/Janssen, Bristol‐Myers Squibb/Pfizer, Biotronik, Medtronic, Boehringer Ingelheim, Microlife, and Daiichi‐Sankyo, and a speaker for Bayer, Bristol‐Myers Squibb/Pfizer, Medtronic, Boehringer Ingelheim, Microlife, Roche, and Daiichi‐Sankyo.

Figures

Figure 1
Figure 1
Example of a display of hypothetical product profiles presented to patients
Figure 2
Figure 2
Oral anticoagulation attributes rated most important in ranking exercise. † indicates p<0.001 vs other groups pooled. * indicated p<0.05 vs other groups pooled
Figure 3
Figure 3
Relative gain in utility values determined from conjoint analysis. Abbreviations: BID, twice a day; OD, once a day
Figure 4
Figure 4
Relative gain in utility values according to stroke knowledge
See this image and copyright information in PMC

References

    1. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64:e1–e76. - PubMed
    1. Heidbuchel H, Verhamme P, Alings M, et al. Updated European Heart Rhythm Association practical guide on the use of non‐vitamin K antagonist anticoagulants in patients with non‐valvular atrial fibrillation. Europace. 2015;17:1467–1507. - PubMed
    1. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37:2893–2962. - PubMed
    1. Hernandez Madrid A, Potpara TS, Dagres N, et al. Differences in attitude, education, and knowledge about oral anticoagulation therapy among patients with atrial fibrillation in Europe: result of a self‐assessment patient survey conducted by the European Heart Rhythm Association. Europace. 2016;18:463–467. - PubMed
    1. Lane DA, Aguinaga L, Blomstrom‐Lundqvist C, et al. Cardiac tachyarrhythmias and patient values and preferences for their management: the European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLEACE). Europace. 2015;17:1747–1769. - PubMed

Publication types

MeSH terms

LinkOut - more resources