Knowledge about atrial fibrillation and anticoagulation affects the risk of clinical outcomes

Abstract

BackgroundKnowledge about atrial fibrillation (AF) and oral anticoagulation (OAC) is insufficient among AF patients. ObjectiveWe examined the association between this knowledge and event rate. MethodsWe studied 174 anticoagulated patients with AF aged 69±10.7 years (median CHA2DS2 -VASc 4). Knowledge was assessed at baseline using the Jessa AF Knowledge Questionnaire (JAKQ). The primary endpoint was a composite of ischemic cerebrovascular events, major or non-major clinically relevant bleeding, and death, recorded during a median follow-up of 42 months. ResultsThe primary endpoint occurred in 48 (27.5%) patients (10.5 per 100 patient-years) including 12 ischemic cerebrovascular events (2.2 per 100 patient-years) and 29 bleeding episodes (5.8 per 100 patient- years). Lower baseline JAKQ scores were associated with the primary outcome (p=0.007), solely when patients who bled during follow-up were compared with the remainder (p=0.007). Patients who were aware of the importance of a regular anticoagulant intake despite the absence of AF symptoms, had, however, a lower risk of cerebrovascular events (p<0.0001). The subjects who experienced bleeding or the primary endpoint were less likely to understand the essence of AF (p=0.03), to know safe painkillers used in combination with OAC (p<0.001), and what to do when the anticoagulant was forgotten (p=0.02). Worse knowledge about AF and OAC, longer OAC therapy, and higher CHA2DS2 -VASc score were independent predictors for the primary endpoint. ConclusionsOur study shows a prognostic value of low knowledge about AF and OAC supporting the need for improved education of AF patients.