Impact of educational program on adherence to direct oral anticoagulant after atrial fibrillation ablation

Abstract

Atrial fibrillation is a common arrhythmia often treated by ablation. The risk for thromboembolic events such as stroke increases in patients especially during the first month after the procedure was performed. Although, adherence to oral anticoagulants is crucial to prevent such complication. This study aimed at assessing the impact of an educational program on adherence to direct oral anticoagulants (DOA) in patients who underwent ablation of atrial fibrillation. This study was a prospective study. Patients, who were admitted in cardiology department at Grenoble university hospital from 08/2018 to 08/2019 for atrial fibrillation ablation and had DOA, were included. The level of adherence to DOA was assessed by phone calls (15 days and 45 days after the procedure) using Girerd Score. During the first call, patients received more explanation about DOA to ensure they had correctly understood the disease, rationale for anticoagulant treatment and importance of adherence. The adherence before and after educational intervention was compared. Of the 338 patients admitted in this period for atrial fibrillation ablation, 214 were included. The mean age was 64.4 ± 9.9 years. Paroxysmal atrial fibrillation was described in 67.6% of the patients. Among the patients, 58.3% were receiving rivaroxaban. Before educational intervention and based on the overall Girerd Score, patients had a high, medium and low adherence in 43.2%, 46% and 10.8% of our sample, respectively. Adherence before and after educational intervention was significantly different (43.2%/46%/10.8% vs. 80.2%/14.8%/5%, P = 0.0001). There was no significant correlation between adherence and the number of doses per day ( P = 0.2). This educational program was effective at raising adherence to DOA. Improvement of adherence to DOA in patients with atrial fibrillation is a critical issue, and measures such as education programs targeted to patients should be undertaken.