Abstract
Treatment preferences are considered a relevant decision-making driver by the main atrial fibrillation (AF) guidelines. Direct Oral Anticoagulants (DOACs), considered as similar clinically, have administration differences useful for treatment individualization. Preferences, priorities and satisfaction of DOAC users were assessed through an observational, multicentric (25 hospitals), cross-sectional study including adult AF-patients (and/or caregivers) in Spain. Three study groups were considered according to DOAC posology preferences: (A) once-daily, with water; (B) once-daily, with food; (C) twice-daily. Overall, 332 patients and 55 caregivers were included. Mean (SD) age was 73.7 (10.7) years [58.7 (13.9) for caregivers]; 51.5% women [69.1% for caregivers]; 80.7% showed comorbidities and poly-pharmacy [6.6 (3.3) drugs/day]. No statistically significant differences were shown among study groups. Once-daily administration was preferred by 274 patients (82.5%) [60.8% (Group A); 21.7% (Group B); 17.5% (Group C)], and 47 caregivers (85.5%) [58.2% (Group A); 27.3% (Group B); 14.5% (Group C)]. Once-daily DOACs were prescribed in 42.8% of the patients. Bleeding risk was the main concern for both, patients and caregivers, followed by DOAC posology and interactions. Although treatment satisfaction (patients and caregivers) was high (9.0 and 9.1 points, respectively), match between individual treatment preferences and real prescriptions was only shown in 41.0% of AF-patients, evidencing a need for patient involvement on treatment decision-making. There is not a patient profile linked to treatment preferences, and clinical criteria must be the main driver for decision-making. However, for most AF-patients (elderly patients), aged, with comorbidity, poly-pharmacy and high cardiovascular risk, once-daily DOACs would be the preferred option.
Highlights
Atrial fibrillation (AF) is the most frequent arrhythmia, affecting around 5% of the population older than 65 years (18% for ≥85 years) [1, 2], and one of the main stroke factor risks [3]
Direct Oral Anticoagulants (DOACs) selection is mainly conducted according to the clinical experience of the prescriber, on a basis of cardiovascular risk, patient comorbidities and potential interactions [17], as non-conclusive studies have been conducted for assessing differences among DOACs and no recommendations or guidelines are available to position these DOACs according to potential patient profiles [4, 17,18,19]
Patients and/or caregivers included in the study were classified in three study arms depending on their main treatment preference regarding DOAC posology: Group A, Group B and Group C
Summary
Atrial fibrillation (AF) is the most frequent arrhythmia, affecting around 5% of the population older than 65 years (18% for ≥85 years) [1, 2], and one of the main stroke factor risks [3]. Vitamin K antagonists (VKA) were the main drugs used to prevent AF-related stroke and systemic embolism [4, 5]. Around 40% of AF-patients receiving VKAs in Primary Care have poor anticoagulation control in Spain [8]. In this context, Direct Oral Anticoagulants (DOACs) have been adopted as useful alternatives to VKAs in routine clinical practice [8,9,10], being at least as effective as warfarin in the prevention of AF-related stroke and systemic embolism, with a better safety profile, regarding intracranial haemorrhage risk [10,11,12,13,14]. DOACs have intrinsic differences that could be used as drivers for drug selection, mainly based on their different posology and administration characteristics [15, 16]
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