Health-related quality of life in nonvalvular atrial fibrillation patients with controlled or uncontrolled anticoagulation status

Cristina Lozano-Duran,José Miguel Seguí-Ripoll,José Felipe Varona,Javier García-Alegría,Juan Bautista Montagud-Moncho,Luis Miguel Cuadrado-Gómez,Antonio Ramos-Guerrero,José Carlos Mirete-Ferrer,Esther Donado

doi:10.1186/s12955-020-01563-1

Abstract

BackgroundThere is a dearth of evidence regarding Health-Related Quality of Life (HRQoL) in nonvalvular atrial fibrillation (NVAF) patients undergoing oral anticoagulation therapy. Our objective was to describe HRQoL in NVAF patients on oral anticoagulation, focusing on uncontrolled patients on vitamin K antagonists (VKAs) versus controlled patients on VKAs or non-vitamin K antagonist oral anticoagulants (NOACs), in a real-world setting. Additionally, we assessed the clinical characteristics of patients with uncontrolled anticoagulation.MethodsAn observational, multicentre, and cross-sectional study, enrolling 38 Spanish Hospitals' Internal Medicine Departments. HRQoL was assessed using the validated Spanish version of the Sawicki questionnaire. High self-perceived HRQoL was indicated by high scores in the general treatment satisfaction and self-efficacy dimensions, and by low scores in the strained social network, daily hassles and distress dimensions.ResultsFive hundred and one patients were included for assessment. Mean scores ± SD were closer to a high perceived HRQoL in controlled than uncontrolled patients for the five dimensions of the questionnaire: 4.9 ± 1.0 versus 3.6 ± 1.3 for general treatment satisfaction; 4.3 ± 1.0 versus 3.6 ± 1.0 for self-efficacy, 3.1 ± 0.9 versus 3.9 ± 1.1 for strained social network, 2.1 ± 0.8 versus 3.0 ± 1.0 for daily hassles and 1.8 ± 0.9 versus 2.6 ± 1.2 for distress.ConclusionsHRQoL in patients with controlled anticoagulant status treated with NOACs or VKAs was better than in patients with uncontrolled anticoagulant status. This seems to indicate that anticoagulation control status influences perception of HRQoL, highlighting the importance of its evaluation when assessing HRQoL in NVAF patients.

Highlights

There is a dearth of evidence regarding Health-Related Quality of Life (HRQoL) in nonvalvular atrial fibrillation (NVAF) patients undergoing oral anticoagulation therapy
In patients treated with vitamin K antagonists (VKAs), the mean ± standard deviation (SD) % therapeutic range (TTR) was 90.3 ± 13.5% in controlled patients and 49.1 ± 10.8% in uncontrolled patients using the Rosendaal method, and 74.9 ± 10.4% in controlled patients and 35.0 ± 15.2% in uncontrolled patients using the direct method
The present study provides valuable findings on HRQoL of NVAF patients under oral anticoagulant treatment with controlled and uncontrolled anticoagulant status in routine clinical practice

Summary

Introduction

There is a dearth of evidence regarding Health-Related Quality of Life (HRQoL) in nonvalvular atrial fibrillation (NVAF) patients undergoing oral anticoagulation therapy. Atrial fibrillation (AF) is the most common type of arrhythmia worldwide [1] and is associated with episodes of heart failure, cognitive decline, cardiovascular morbidity, an increased mortality risk and a decreased quality of life (QoL) [2,3,4,5,6]. Almost half of the patients are outside of the therapeutic range more than 50% of the time [13, 14], and women are at a higher risk of poor INR control [15], with the increased probability of thromboembolic events that uncontrolled INR implies

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