Duke Anticoagulation Satisfaction Scale Research Articles

The effect of face-to-face and online education provided to individuals with atrial fibrillation on medication adherence and satisfaction.

This randomized controlled study was conducted to investigate effects of face-to-face education and tele-education given to individuals with atrial fibrillation (AF) taking oral anticoagulants on their medication compliance and satisfaction levels. The study sample comprised 150 individuals. Of them, 50 were assigned to the control group, 50 to experimental Group 1, and 50 to experimental Group 2. Data were collected with the Descriptive Information Form, Medication Compliance Notification Scale, and Duke Anticoagulation Satisfaction Scale (DASS). Intervention Group 1 was given face-to-face education. Intervention Group 2 was given tele-education. The control group underwent no intervention. The scales were administered to all the groups twice. Intragroup analysis demonstrated that the Medication Compliance Notification Scale score of the face-to-face education group increased significantly in the final measurement compared to those of the control group and tele-education group. Intergroup analysis demonstrated that the DASS scores of the three groups significantly differed. The difference stemmed from intervention Group 1. Face-to-face education given to individuals with AF on oral anticoagulants improved their medication compliance and medication satisfaction levels. Nurses should primarily use face-to-face education in the care and education programs of individuals with AF.

Validation in Colombian Spanish of DASS (Duke Anticoagulation Satisfaction Scale)

Validation in Colombian Spanish of DASS (Duke Anticoagulation Satisfaction Scale)

Quality of Life of Patients Receiving Warfarin Therapy at a Tertiary Care Centre in Indonesia Using DASS (Duke Anticoagulation Satisfaction Scale).

This study aimed to examine the quality of life of patients receiving warfarin therapy at Dr. Hasan Sadikin Central General Hospital, and its relationship with demographic factors. The procedures started with the submission of a study permit, followed by validation of the Duke Anticoagulation Satisfaction Scale (DASS) questionnaire. In addition, the validated questionnaire was completed by the participants, and significant variables were analyzed using the chi-square method for multivariate analysis. The results showed that the questionnaire was valid and could be used for further analyses. Among the 88 selected participants, 52 and 36 had scoring categories <56.266 and 56.266 ≤ x ≤ 143.734, respectively, with no patients having a scoring category > 143.734. In addition, participants with low education and aged ≥ 52 years were 4.916 and 3.161 times more at risk of having quality of life score of 56.266 ≤ x ≤ 143.734, respectively. Based on the results, the average quality of life score of patients was 59.66. Participants with low educational levels and those aged ≥ 52 years were at a higher risk of having quality of life score of 56.266 ≤ x ≤ 143.734. In summary, a lower quality of life score was linked to increased comfort and satisfaction among patients receiving warfarin treatment. Additionally, these patients experienced fewer feelings of limitations and inconveniences related to their treatment plans.

Living on Oral Anticoagulants: Duke Anticoagulation Satisfaction Scale Results.

Direct oral anticoagulants (DOACs) are widely used in patients with atrial fibrillation and venous thromboembolism. The lack of the need for laboratory monitoring and a better safety than vitamin K antagonists (VKAs) has probably changed the quality of life of patients on these oral anticoagulants. This was a real-life prospective observational cohort study. The aim was to evaluate if a long-term treatment with DOACs could offer a better quality of life than VKAs. Moreover, age, gender, education level, time in therapeutic range for VKAs, taking medication once or twice a day for DOACs, the total daily number of medications and thrombotic and bleeding complications were considered as variables probably associated with the quality of life of these patients. Between January and December 2021, the Duke Anticoagulation Satisfaction Scale (DASS) 25-items was administered as an interview to patients on either VKAs or DOACs therapy. During the follow-up period, all of the patients were closely monitored to evaluate possible bleeding and thrombotic events. The analysis included 300 outpatients treated with VKAs and 254 treated with DOACs. In general, the quality of life was better in patients taking DOACs (DASS total score: DOACs = 44.7, 42.9-46.5 vs. VKAs = 51, 49.2-52.8, p < 0.0001) as the daily-life limitations, hassles and burdens and the psychological impact were less important than in patients on VKAs therapy. VKAs negatively influence the daily-life of the patients in terms of both less satisfaction and time-consuming tasks. DOACs confer a better quality of life even if some concerns emerge from not knowing how their therapy is working.

Assessment of satisfaction level of patients using oral anticoagulants in Qassim, Saudi Arabia

Background : Understanding patients&amp;apos; satisfaction levels and expectations towards anticoagulant use will guide health professionals to plan treatment and care and improve patient care quality. Therefore, this study aimed to examine the satisfaction level and associated factors among patients using oral anticoagulants in Qassim, Saudi Arabia. Methods: A observational cross-sectional study was conducted among patients who use oral anticoagulant therapy in Qassim, Saudi Arabia. The data collection tool included questions assessing the demographic characteristics of patients and 15 questions modified from the Duke Anticoagulation Satisfaction Scale (DASS). It was distributed to the participants from 11 April 2023 to 18 April 2023 through a Google form. Results: Out of 106 subjects accepted to participate in the study. Most participants were female (82.1%) and from Saudi Arabia (96.2%). The participants ranged from 18 to over 75 years, the highest percentage aged from 31 to 55 years (48.1%), and two-thirds of participants were married (69.8%). Only 25.5% of participants were on anticoagulation therapy, and most had been on therapy for one year or less (77.4%). The total score of the modified DASS had a median score of 45, with an IQR of 6. The burdens and hassles, positive impacts, and limitations subscales median (IQR) scores were 5 (6), 29 (15), and 10.50 (10), respectively. The educational level had a significant effect on positive impacts (p-value=0.023), with participants with less than a university degree reporting higher scores in this subscale than those with higher educational levels. Conclusion: It was found that participants with lower educational levels reported higher scores in the positive impact subscale. In contrast, those on anticoagulation therapy reported higher burdens and hassles, lower positive impact, and higher limitation scores.

LEAP Pilot: Low Molecular Weight Heparin Vs. Aspirin Postpartum

Background Expert opinion from the American Society for Hematology (ASH), the Royal College of Obstetricians and Gynecologists, UK, as well as the 'Society of Obstetricians and Gynecologists of Canada guidelines recommend a minimum of 6 weeks of prophylactic LMWH for patients with a history of venous thromboembolism (VTE) or high-risk thrombophilia. There are no randomized controlled trials (RCTs) determining the optimal duration of anticoagulation postpartum. A 2014 Cochrane review concluded that there is insufficient evidence on which to base thromboprophylaxis in the pregnancy postpartum setting, and high-quality randomized trials are warranted. Clinical trials and meta-analyses have suggested that ASA administered daily post-operatively may be non-inferior to LMWH for VTE prophylaxis; (RR 0.76; 95% CI, 0.37- 1.56 in one study), with a similar safety profile. Furthermore, in 2018 Anderson et al. demonstrated clinical safety and non-inferiority of a combination of 5 days of rivaroxaban followed by 81mg of ASA for 30 days after total hip arthroplasty and 9 days after total knee arthroplasty. The principal question to be addressed in a large definitive randomized controlled trial (RCT) is whether a combination of prophylactic LMWH for 3 weeks followed by low-dose ASA for the following 3 weeks is non-inferior to the standard of care of prophylactic LMWH for 6 weeks postpartum. This single-center pilot RCT addresses enrollment, adherence and feasibility required prior to conducting a definitive trial. Study Design and Methods Inclusion criteria: 1) Personal history of VTE prior to pregnancy and not prescribed therapeutic anticoagulation 2) Family history of VTE and antithrombin deficiency, protein C or protein S deficiency 3) Combined thrombophilia or homozygous for factor V Leiden mutation or prothrombin gene mutation, regardless of family history. Sample size: 50 patients, 25 patients treated according to each strategy. Primary outcomes: 1) Enrollment/consent rate 2) Adherence to study protocol 3) Loss to follow-up/missing data. Secondary outcomes: 1) VTE rate 2) Bleeding rate three months following delivery 3) Quality of life assessment (QoL) (Duke Anticoagulation Satisfaction Scale). Results The enrollment rate was 69.2%, with 18 of 26 patients agreeing to participate. Of the 18 recruited, one was randomized in error, one had an early pregnancy loss, and one developed a superficial vein thrombosis antenatally due to non-compliance with antepartum anticoagulation, leaving 15 patients satisfying inclusion criteria. 9 patients have completed their 3-month postpartum follow-up, with no patients lost to follow-up. The adherence to treatment at 3 weeks was 96.4% and 94.0% in Group A (LMWH and ASA) and B (LMWH), respectively (p=0.7). At 6 weeks postpartum, there was a trend toward greater treatment compliance in Group A vs Group B (98.2 vs 94.1%); however, this was not statistically significant (p=0.52). With regards to secondary outcomes, there was no VTE documented in either treatment group. One patient in each group reported mild gingival bleeding. No other bleeding events were reported. The QoL assessment score in Group A improved by 56% following the change from LMWH to ASA (39.5 to 16.8), whilst it deteriorated in Group B by 2% (24.5 vs 25.2). At 6 weeks postpartum, the QoL score improved by 33.3% in Group A vs Group B (P=0.01). Conclusion Our data shows promising enrollment, adherence, loss to follow-up and feasibility of our ongoing pilot trial. The results of this study will be used to design first a multicenter pilot study then a large definitive multicentered trial. Demonstration of non-inferiority of ASA and LMWH to LMWH will lead to a shorter course of LMWH postpartum, potentially reducing bleeding risk, need for subcutaneous injections, as well as cost, while improving quality of life. If the definitive trial does not show non-inferiority, the results will provide evidence that six weeks of postnatal thromboprophylaxis with LMWH is warranted.

Health-Related Quality of Life among Atrial fibrillation Patients Undergoing Anticoagulation Therapy

In Malaysia, studies sought to evaluate the health-related quality of life (HRQoL) among patients undergoing anticogaultaion therapy are still recent and scarce as there is no specific tool available. This cross sectional descriptive study was undertaken with a representative cohort of atrial fibrillation patients undergoing anticoagulation therapy. Using prevalence based sampling techniques, a total of 339 patients were recruited from the Anticoagulation Clinics at two public hospitals in Penang, Malaysia. A bilingual specific instrument; Duke Anticoagulation Satisfaction Scale (DASS) and a generic instrument; the European Quality of Life scale (EQ-5D-3L) were used for data collection. The mean (SD) age of the patients was 60.4±14.5 years, with 204 (60.2%) males dominating the entire study. The majority of patients were from lower socioeconomic level and one third of subjects had a secondary level of education. DASS instrument presented a good average score of 70.8 (±19.8), while the means±SD of EQ-VAS was 69.3% (± 16.3%) and for the EQ-Index (TTO) was 79.8% (± 26.5%) indicated satisfactory health related quality of life (HRQoL) in our study participants.&#x0D; Their QoL perception is affected positively by age, education level, and occupation and negatively by sex gender and previous hemorrhagic event. The worse evaluations were in mobility and pain domains. Consequently, it was noted that warfarin therapy is not usually associated with a significant decrease in perceived health, unless a bleeding episode has occurred. Results from this study could be useful in clinical practice, particularly in newly detected AF patients, at point where improving HRQoL is still possible.

The Transcultural Adaptation and Validation of the Chinese Version of the Duke Anticoagulation Satisfaction Scale.

Background: The Duke Anticoagulation Satisfaction Scale (DASS) offers a method to measure the quality of life and satisfaction of patients taking oral anticoagulants. The study aimed to validate the Chinese version of the DASS in Chinese patients on anticoagulation therapy. Methods: The DASS was translated, back-translated, and transculturally adapted into the Chinese version and then administered to participants taking oral anticoagulants in a physician–pharmacist collaborative anticoagulation clinic at a tertiary teaching hospital from October 2019 to December 2020. Reliability was analyzed through Cronbach’s alpha (α) and split-half reliability. Confirmatory factor analysis was performed to test the structural validity of the scale. Exploratory factor analysis was performed for items in the scales using the varimax rotation method. Results: A total of 189 patients completed the Chinese version of the DASS. Four dimensions and 23 items were included, with Cronbach’s α values of 0.89, 0.81, 0.89, and 0.74 for limitations on physical activities, diet restrictions, hassles and burdens, and positive psychological effect, respectively. Cronbach’s α coefficient of whole scale was 0.91. The split-half reliability of this scale is 0.747 (>0.7). Conclusion: The Chinese version of the DASS indicated excellent reliability and validity, compared to the original version. It could provide a practical instrument for healthcare practitioners to evaluate satisfaction and quality of life for anticoagulated patients in China. The difference in quality of life between patients taking warfarin and novel oral anticoagulants (NOACs) needs to be further explored in future studies.

The effect of reinforcing an educational programme using telephone follow-up on health-related quality of life of individuals using warfarin: A randomised controlled trial.

To evaluate the effect of reinforcing an educational programme through telephone follow-up on health-related quality of life and anxiety and depression symptoms in individuals starting warfarin therapy. Educational interventions have improved quality of life in individuals using warfarin. Few studies have examined the addition of telephone follow-up to enhance educational interventions. Randomised controlled trial in outpatient setting. Hospitalised adults starting warfarin therapy who agreed to participate received an educational programme about the warfarin treatment. At discharge, they were randomised to receive either five telephone follow-up calls (intervention) or no telephone calls (controls). Both groups were evaluated for health-related quality of life (using Duke Anticoagulation Satisfaction Scale) and symptoms of anxiety and depression (using Hospital Anxiety and Depression Scale) at three and six months post-discharge. Groups were compared at each time by independent-samples t test, and over time by repeated-measures analysis of variance, with time (three and six months), groups (intervention and control) and an interaction between time and group as factors. Level of significance was set at 0.05. The Consolidated Standards of Reporting Trials was used for reporting. Fifty-two individuals (26 per group) completed the study. There were no statistical differences between groups in health-related quality of life, anxiety and depression symptoms, at both times post-discharge. Participants who received follow-up telephone calls reported better positive psychological impact (a subscale of quality of life) than controls. Reinforcing an educational programme with telephone follow-ups did not have an overall effect on health-related quality of life of individuals using warfarin but promoted positive psychological impact. The low cost of reinforcing educational programmes with telephone calls and the improvement in positive psychological aspects indicate that this type of intervention is still a promising intervention that could be further investigated and improved.

Self-perceived quality of life of primary antiphospholipid syndrome patients using vitamin K antagonist

Primary antiphospholipid syndrome (PAPS) is a chronic autoimmune disorder clinically characterized by thromboembolic events or obstetric complications. Prolonged anticoagulation therapy with vitamin K antagonists (VKA) is the treatment of choice for PAPS patients with thrombosis. However, the efficacy of VKA therapy depends on laboratory monitoring, dose adjustment, adequate lifestyle and adherence to treatment. Difficulties with VKA therapy can affect patients' self-perceived health related quality of life (HRQOL). This study aims to evaluate PAPS patients' HRQOL, therapy adherence and knowledge of treatment. A general Medical Outcome Study Short Form-36 (SF-36) and the Duke Anticoagulation Satisfaction Scale (DASS) were used to access APS-patients self-perceived HRQOL. Treatment adherence was measured by the Treatment Measure Adhesion (TMA) - oral anticoagulant version instrument, and knowledge of VKA treatment was measured using the MedTake test. 66 PAPS patients using VKA were assessed. 63% of them were female; the mean age was 41.9 years old, approximately 60% had unprovoked venous thrombosis and one third of the patients had recurrent thrombotic events. The most impacted domain of DASS was "psychological impacts" and the factors associated to anticoagulation related poor HRQOL were: female sex, presence of arterial thrombosis and INR lability. Using the SF-36 instrument, PAPS-patients self-perceived HRQOL was poorer than that of the general Brazilian population and was associated with female sex and presence of cardiovascular risk factors. Despite the high adherence to treatment and knowledge of VKA therapy, self-perceived HRQOL is poor in patients with PAPS and is mainly affected by VKA therapy. Searching for better treatment options is warranted.

Validation and Psychometric Properties of the Arabic Version of the Duke Anticoagulation Satisfaction Scale (DASS).

Background: To assess the health-related quality of life (HRQoL) of oral anticoagulant therapy users, different types of instruments are available, either general or specific tools like Duke Anticoagulation Satisfaction Scale (DASS). These tools allow the clinician to adjust the treatment regimen to focus on increasing anticoagulation adherence and reduce adverse clinical outcomes. This study aims to validate the translated Arabic version of DASS to assess the satisfaction level of patients using oral anticoagulants in the Arab population. Methods: The Duke Anticoagulation satisfaction scale (DASS) was translated into the Arabic language using MAPI group services. DASS was administered to 505 patients receiving anticoagulation with warfarin or apixaban. The generic scale measuring the quality of life EQ-5D-5L was also administered. Psychometric properties were assessed by Confirmatory Factor Analysis, internal consistency (Cronbach’s Alpha), exploratory factor analysis, convergent and divergent validity, and the correlation between the DASS and demographic variables, clinical characteristics, and the EQ-5D-5L instrument. Results: 439 subjects answered all the questions. From a total of 25 items, 22 grouped into three factors (limitations, positive impact, and negative impact). Each factor had good internal consistency (Cronbach Alpha 0.78–0.88). All the three factors correlated consistently with EQ-5D-5L measuring generic quality of life. Conclusion: The psychometric properties of the Arabic DASS version were comparable to the original English version. The Arabic version of the DASS showed very good reliability and validity. It can be used by health care professionals in other settings of anticoagulation clinics to assess patient’s satisfaction and limitations to anticoagulant treatment.

Satisfaction of Patients with Nonvitamin K Anticoagulants Compared to Vitamin K Antagonists: a Systematic Review and Meta-analysis.

To undertake a systematic review and meta-analysis to assess the satisfaction of patients receiving nonvitamin K anticoagulants (NOACs), compared with vitamin K antagonists (VKAs). We searched CENTRAL, MEDLINE, Embase, and Clinicaltrials.gov for randomized controlled trials (RCTs) and observational studies. Two reviewers screened, extracted, and appraised data independently. We pooled data using a random-effects model. Outcome included treatment satisfaction, which was assessed by scores of Duke Anticoagulation Satisfaction Scale (DASS), Anticlot Treatment Scale (ACTS), Perception of Anticoagulant Treatment Questionnaire 2 (PACT-Q2), or Treatment Satisfaction Questionnaire for Medication version II (TSQM-VII) and their domains reported with 95% confidence intervals (95% CIs). We followed MOOSE and PRISMA guidelines. We included four RCTs and 16 observational studies, enrolling 18,684 participants overall. Compared with VKAs, treatment with NOACs improved the ACTS Burdens score by 4.21 points (95% CI: 2.99-5.43, I 2 = 95%, combined n = 6,180), and ACTS Benefits by 0.49 points (95% CI: 0.18-0.81, I 2 = 85%, combined n = 6,171). Switching from VKAs to NOACs improved the ACTS Burdens score by 5.33 points (95% CI: 3.53-7.14, combined n = 3,097). Compared with VKAs, treatment with NOACs improved the TSQM-VII Global Satisfaction score by 6.86 points (95% CI: 3.00-10.73, combined n = 5,535). In patients with nonvalvular atrial fibrillation or venous thromboembolism, NOAC treatment is associated with greater satisfaction compared with VKAs. The switch from VKAs to NOACs was associated with improved patients' satisfaction. These effects were largely due to a lower degree of treatment burden with NOAC treatment.

The Effect of Nurse Home-Support Program on Self-Management of Patients Receiving Oral Anticoagulation (Warfarin) Therapy.

AimWarfarin, which is widely used for preventing thromboembolic events, can cause major and minor side effects. The aim of this trial is to evaluate the effect of nurse home-support program on self-management of patients receiving warfarin therapy.MethodA randomized, controlled trial was conducted using 36 selected and eligible patients who had 12-month home-visit follow-ups. The bleeding risk score, potential and preventable warfarin-related complications, patients’ self-management behaviors, and anticoagulation satisfaction were examined. Data analyses were performed using parametric and nonparametric tests, split-plot analysis of variance, multiple regression analysis, and Bland and Altman plots test.ResultsThe bleeding risk score was an effective variable for assessing patient satisfaction (p<0.05). The self-management group demonstrated decreased bleeding risk at the end of the trial. The Duke Anticoagulation Satisfaction Scale mean score represents a statistically significant improvement in the self-management group (p<0.05). Patients’ self-management behaviors improved significantly in the self-management group compared to the control group (p<0.05). The number of international normalized ratio values within the target range was significantly higher in the self-management group (174/432) than in the control group (82/432). The self-management group showed significant reductions in both thromboembolic events.ConclusionThis trial demonstrated evidence that use of nursing home care is effective in developing self-management behaviors, improving patient satisfaction, and preventing complications in patients receiving warfarin therapy. This model could be easily adopted and implemented by home care services and health organizations.

Implementation of home-based international normalized ratio testing in adult patients treated with warfarin.

Patients who take warfarin require frequent testing of their international normalized ratio (INR) level to ensure accurate dosage. Frequent testing can be inconvenient for patients in rural settings, the workforce, the homebound, or those who travel. Patients who have a home INR monitor can test their blood remotely. To circumvent barriers to INR testing, a quality improvement project was designed to implement home INR testing in an anticoagulation clinic setting. Patients who received a home INR monitor were compared against two usual care testing arms (laboratory and clinic testing patients) in the outcomes of time in therapeutic range (TTR), adverse events, and patient satisfaction using the Duke Anticoagulation Satisfaction Scale (DASS). The DASS survey demonstrated the home testing patients had a statistically significant advantage over the clinic testing group in the subdomain of hassles and burdens (p = .048), as well as the lowest overall scores (indicating highest satisfaction) over the clinic testing group (p = .041). No patients in the home testing group had clotting or bleeding issues necessitating hospital admission. There were no significant differences between groups in the TTR analysis (laboratory 70.8%, home 68.9%, and clinic 64.5%) (p = .683). Home INR testing provides convenience for patients and reduces the hassles and burdens of warfarin management, leading to improved satisfaction. This engagement in self-care translates to reduced adverse events. Home INR testing can be used in warfarin patients who are highly motivated and willing to engage in their care.

Validation and psychometric properties of the Maltese version of the Duke Anticoagulation Satisfaction Scale (DASS).

PurposeAssessing treatment satisfaction can guide specific interventions to improve anticoagulation adherence and reduce adverse outcomes. We aimed to assess the psychometric properties (reliability and validity) of the Maltese translation of the Duke Anticoagulation Satisfaction Scale (DASS).Patients and methodsThe DASS explores three dimensions (limitations, hassles/burdens, psychological impact). The translation process included forward and backward translations. Reliability was evaluated through internal consistency and reproducibility. Validity was evaluated through floor/ceiling effect, convergent/discriminant validity, construct validity, and known-group validity.ResultsThe Maltese version of the DASS, administered to 174 patients on warfarin for different clinical indications, showed good reliability (Cronbach’s alpha 0.87; intraclass correlation coefficient for test–retest 0.73). Floor effect was identified mainly in the limitations and hassles/burdens subscales. Significant positive correlations were found between the DASS total score and its subscales (limitations 0.80, hassles/burdens 0.85, psychological impact 0.68). Female sex, shorter warfarin treatment duration (≤5 years), previous hospitalization and history of bleeding were associated with lower satisfaction.ConclusionPsychometric properties of the Maltese DASS were comparable to the original English version. The Maltese version of the DASS is a valid and reliable instrument that can be used by health care professionals to assess the level of satisfaction of Maltese-speaking anticoagulated patients.

Relationship Between Anticoagulant Medication Adherence and Satisfaction in Patients With Stroke.

The aim of this study was to investigate the accuracy of the self-reported measure of adherence and the relation between adherence to warfarin use, demographic and clinical variables, and the satisfaction with the treatment in patients affected by stroke. This is a correlational, quantitative, and cross-sectional study, carried out in the outpatient clinics of a public university hospital from October 2017 to April 2018. Sociodemographic and clinical data were collected through interviews and hospital charts, as well as by applying the Measurement of Treatment Adherence (MTA) and the Duke Anticoagulation Satisfaction Scale, in their Brazilian versions. Results of the international normalized ratio (INR) were collected. Measurements of accuracy of the MTA scale were calculated in relation to the INR classification. Of 99 patients (55.6% male with a mean age of 58.6 years), 57.6% presented with therapeutic INR values and 75.8% of the patients were adherent to the oral anticoagulant therapy according to the MTA. The accuracy analysis of the measurement provided by the MTA scale in relation to the INR classification showed a sensitivity of 77.2% and a specificity of 26.2%. The patients' satisfaction with the treatment was high. The Duke Anticoagulation Satisfaction Scale had an average total score of 46.4, with the dimension impact in the field having the highest score (20.3). Stroke patients were adherent and satisfied with the oral anticoagulant therapy. The MTA had good sensitivity and poor specificity. Sociodemographic and clinical characteristics identified were not associated with adherence and satisfaction with treatment.

Effects of Direct Oral Anticoagulants on Quality of Life During Periprocedural Management for Dental Extractions

Direct oral anticoagulants (DOACs) have many advantages over warfarin regarding periprocedural management for dental extractions. They avoid the need to assess and possibly adjust warfarin therapy to achieve appropriate hemostatic status before and after extraction. The present study evaluated the real-life data regarding quality of life (QoL) and burden for patients with atrial fibrillation receiving long-term treatment with warfarin or DOACs during periprocedural management for dental extraction. We implemented a multicenter study. The sample was composed of 205 patients who had been receiving long-term anticoagulation treatment with warfarin (n=133) or DOACs (n=72). The Duke Anticoagulation Satisfaction Scale (DASS) was used to assess the QoL. Periprocedural management for dental extraction was recorded using the questions designed by us. Warfarin created a significantly greater burden for patients during periprocedural management for dental extraction compared with DOACs. The DASS results showed that the QoL of patients was significantly better for the DOAC group than for the warfarin group (score, 75.19±18.52 and 90.12±17.28, respectively; P=.0001). Of the patients in the DOAC group, 45 had used warfarin as their previous therapy and had undergone another tooth extraction while using warfarin. Of these patients, 91.1% chose DOACs as their anticoagulant of choice for dental extraction. The present findings suggest that DOACs have many advantages compared with warfarin regarding the reported QoL and periprocedural management of dental extraction.

Comparison of claims vs patient-reported adherence measures and associated outcomes among patients with nonvalvular atrial fibrillation using oral anticoagulant therapy.

ObjectiveTo compare oral anticoagulant (OAC) adherence among patients with nonvalvular atrial fibrillation (NVAF) using patient-reported and claims-based measures, and to evaluate the effect of OAC adherence on health care costs and patient satisfaction with OAC therapy.MethodsThis was a hybrid US observational study consisting of a longitudinal cohort survey followed by linkage and analysis of respondents’ administrative claims data. Patients with NVAF receiving warfarin, dabigatran, rivaroxaban, or apixaban completed an initial survey and follow-up surveys at 4, 8, and 12 months. Patient-reported adherence was measured at each survey by Morisky Medication Adherence Scale (MMAS-8) and pharmacy claims-determined adherence by the proportion of days covered (PDC) for the 12-month period following the initial survey date; adherence was defined as MMAS-8 score =8 and PDC ≥80%. Patient satisfaction with OAC therapy was assessed by the Duke Anticoagulation Satisfaction Scale (DASS).ResultsOverall, 675 patients completed at least the initial survey (warfarin, n=271; dabigatran, n=266; rivaroxaban, n=128; apixaban, n=10). Fewer than half (47.9%) were PDC adherent, 37.2% were MMAS-8 adherent, and 19.4% were adherent by both measures. Total medical costs of PDC-adherent patients were significantly lower vs PDC-nonadherent patients (US$640 vs $993 per-patient per-month, respectively, p<0.05). MMAS-8-adherent patients reported higher treatment satisfaction; total DASS score was significantly lower among MMAS-8-adherent than MMAS-8-nonadherent patients (37.3 vs 42.9, respectively, p<0.001).ConclusionUsing claims-based or patient-reported methods to measure OAC adherence may lead to different results when assessing impact on health care costs and satisfaction with anticoagulation medication. These results underscore the importance of considering both claims-based and patient-reported measures when evaluating treatment adherence in real-world settings.

The first pharmacist-managed anticoagulation clinic under a collaborative practice agreement in Qatar: clinical and patient-oriented outcomes.

Optimal outpatient anticoagulation management requires a systematic and coordinated approach. Extensive evidence regarding the benefits of pharmacist-managed anticoagulation services has been reported in the literature. The quality and outcomes associated with pharmacist-managed anticoagulation clinics under collaborative practice agreements in the Middle East have rarely been reported. The first pharmacist-managed ambulatory anticoagulation clinic in Qatar was launched at Al-Wakrah Hospital in March 2013. The objectives of this study were to: (i) describe the practice model of the clinic, (ii) evaluate the quality of the clinic [i.e. the time in therapeutic range (TTR)] and the clinical outcomes (i.e. the efficacy and safety), and (iii) determine the patients' satisfaction and overall quality of life (QoL). Clinical outcome data were collected through a retrospective chart review of all patients managed from March 2013 to October 2014 at the pharmacist-managed anticoagulation clinic. Furthermore, the patient-oriented outcomes data were prospectively collected using the 24-item Duke Anticoagulation Satisfaction Scale (DASS). Each item was assessed using a 7-point Likert-type scale on which lower scores indicated better QoL and greater satisfaction. The clinical outcome data analyses included 119 patients who were enrolled at the clinic during the 19-month study period. The mean number of international normalized ratio (INR) tests/month was 65 ± 9, the average testing frequency was 2·7 ± 1·6 weeks, and the average %TTR was 76·8 ± 22·9%. There was one major bleeding event (0·67%/year), 12 minor bleeding events (8%/year) and two thromboembolic events (1·35%/year) recorded during the study period. Of the 119 patients, 50 participated in the satisfaction and QoL survey. The median (IQR) total QoL score of these subjects was 63 (48) (minimum-maximum achievable score: 24-168). Seventy-six per cent of the patients indicated 'a lot to very much' in terms of their overall satisfaction with the anticoagulation treatment. The participants who were naïve to anticoagulation treatment reported a significantly greater satisfaction and better QoL than the experienced patients [58 (44) vs. 82 (59); P = 0·009]. These findings provide early evidence that the patients who were managed at a pharmacy-based anticoagulation clinic in an evolving healthcare system experienced optimal anticoagulation management.

Quality of life (QoL) and International Normalized Ratio (INR) control of patients attending anticoagulation clinics

ObjectivesTo investigate association between quality of life (QoL) and International Normalized Ratio (INR) control, with the secondary aim of assessing QoL using generic and anticoagulation-specific, the Short Form Health Survey (SF-12) and the Duke Anticoagulation Satisfaction Scale (DASS). Study designThis study assessed anticoagulation related QoL at three time intervals in two groups of patients on long-term warfarin therapy. MethodsData of 326 randomly sampled patients (163 patients each in DASS and SF-12 groups) who had been on warfarin therapy for at least one year at anticoagulation clinics were analysed. QoL was assessed at three time intervals: at the start, six months and one year of warfarin therapy. Indications and target INR ranges and subjects INR values were recorded. Time in Therapeutic Range (TTR) was estimated for four subject subgroups, based on target ranges of INR for clustered indications. ResultsOf the total, 43% of the subjects were aged between 50 and 64 years, and 51% were female. DASS assessed subjects older than 35 years perceived significant decrease in overall mean scores of anticoagulation related QoL, whilst all SF-12 assessed subjects perceived an increase in QoL. The mean percentage days in range for all INR target range subgroups did not exceed more than 60% but there was only a weak correlation (Rs = 0.104, P > 0.05) between INR control and overall QoL. ConclusionMalaysian urban outpatients on warfarin treatment longer than one year report a significant overall decrease in QoL, as measured using a validated condition-specific instrument. These patients appeared to adapt well to lifestyle limitations imposed by long-term anticoagulation.