Lane Deirdre A, Meyerhoff Juliane, Rohner Ute, Lip Gregory Y H
Institute of Cardiovascular Sciences, University of Birmingham, UK.
Boehringer Ingelheim Pharma International GmbH, TA Cardiometabolism/Medicine Cardiology Ingelheim am Rhein, Germany.
Clin Cardiol. 2018 Jun;41(6):855-861. doi: 10.1002/clc.22971. Epub 2018 Jun 12.
Guidelines recommend that patients with atrial fibrillation (AF) are involved in oral anticoagulant (OAC) treatment decisions. Understanding which OAC attributes AF patients value most could help optimize treatment.
To assess the relationship between patient's stroke knowledge and their preferences for specific OAC attributes.
A cross-sectional online survey was conducted in patients with nonvalvular AF taking an OAC for stroke prevention in the United States, Canada, Germany, France, and Japan. Patients were asked about their stroke knowledge, perception of the seriousness of AF and concern about stroke, and to rank 7 OAC attributes in order of importance. A conjoint analysis was performed to determine the inherent value of 4 attributes.
In total, 937 patients (mean age [standard deviation] 54.3 [16.6] years; 37.1% female) participated. Of these, 19.5%, 27.9%, and 29.8% had good, moderate, and low stroke knowledge, respectively; 22.8% had no stroke knowledge. Overall, 39.4% of patients (47.5% with good stroke knowledge) perceived AF as very/extremely serious. The OAC attribute ranked as most important was stroke prevention followed by major bleeding risk, other side effects, dosing frequency, antidote availability, dietary restrictions, and use with/without food. In the conjoint analysis, stroke risk reduction was the most valued property, followed by reduction in major bleeding risk, less frequent administration, and administration with/without food. Preferences did not differ with level of stroke knowledge, perception of seriousness of AF, concern of stroke, or medication burden.
Most AF patients consider efficacy and safety to be the most important OAC attributes, whereas dosing frequency was deemed as less important.
指南建议心房颤动（AF）患者参与口服抗凝药（OAC）治疗决策。了解AF患者最看重哪些OAC属性有助于优化治疗。
评估患者的卒中知识与其对特定OAC属性的偏好之间的关系。
在美国、加拿大、德国、法国和日本，对正在服用OAC预防卒中的非瓣膜性AF患者进行了一项横断面在线调查。询问患者有关他们的卒中知识、对AF严重性的认知以及对卒中的担忧，并按重要性顺序对7种OAC属性进行排序。进行联合分析以确定4种属性的内在价值。
共有937名患者（平均年龄[标准差]54.3[16.6]岁；37.1%为女性）参与。其中，分别有19.5%、27.9%和29.8%的患者具有良好、中等和低水平的卒中知识；22.8%的患者没有卒中知识。总体而言，39.4%的患者（47.5%具有良好卒中知识）认为AF非常/极其严重。排名最重要的OAC属性是预防卒中，其次是大出血风险、其他副作用、给药频率、解毒剂可用性、饮食限制以及与食物同服/不同服。在联合分析中，降低卒中风险是最受重视的属性，其次是降低大出血风险、给药频率较低以及与食物同服/不同服。偏好与卒中知识水平、对AF严重性的认知、对卒中的担忧或药物负担无关。
大多数AF患者认为疗效和安全性是OAC最重要的属性，而给药频率则被认为不太重要。
