Abstract 213: Lower Satisfaction in Atrial Fibrillation Patients Taking Warfarin-Thromboprophylaxis Versus Non-Warfarin-Thromboprophylaxis

Abstract

Introduction: Warfarin reduces the risk of stroke in atrial fibrillation (AF) patients by up to 65%; however, there are significant disadvantages to warfarin therapy, including complex and variable dosing, inconvenient monitoring and potentially dangerous food and drug interactions. We sought to evaluate and compare patient-reported feelings of limitation, concern and burden when receiving warfarin- vs. non-warfarin-thromboprophylaxis. Methods: We conducted a cross-sectional survey study of AF patients receiving various agents for thromboprophylaxis for stroke prevention. Patients were recruited from arrhythmia clinics associated with a large, urban teaching hospital. Each patient completed the “Anti-Clot Treatment Scale” (ACTS) survey instrument. Mean scores of patients receiving and not receiving warfarin were compared for each of the 17 items and for the “Burdens” (questions 1-12) and “Benefits” (questions 14-16) subscales. The Burdens and Benefits subscales are scored so that a higher score suggests greater satisfaction. Results: A total of 80 AF patients completed the survey. Of these, 65 were receiving a regimen containing warfarin (n=39 warfarin, n=26 warfarin+antiplatelet agent(s)) and 15 were not (n=11 aspirin, n=2 aspirin+clopidogrel, n=2 dabigatran). The mean age of surveyed patients was 74.2±9.7; 60% were male, and the mean CHADS2 score was 2.1±1.2. Six of the 17 individual questions, depicting patients perceived limitations in physical activity due to bleeding, limitations on diet, feelings of inconvenience of occasional aspects of anti-clot therapy, frustration, burden and overall negative impact on life, had significantly less favorable scores in warfarin patients compared to patients not receiving warfarin (p<0.05 for all). Mean ACTS Burdens scores were higher (more favorable) in the no warfarin group (44.5±6.4) compared to the warfarin group (39.8±8.0) (p=0.003). No significant difference was seen between the 2 groups in regards to the ACTS Benefits score (11.1±3.4 vs.10.4±3.7, p=0.38). Conclusion: AF patients receiving warfarin had less favorable feelings about their thromboprophylaxis. Warfarin-treated patients reported more limitations and suffered greater feelings of burden.