Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, MacKay Medical College, New Taipei City, Taiwan, ROC.
MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2021 Apr 1;84(4):375-382. doi: 10.1097/JCMA.0000000000000496.
Patient satisfaction with oral anticoagulant (OAC) therapy is an important metric of care quality and has been associated with higher medication persistence. Among OACs, dabigatran has been shown to be non-inferior to vitamin K antagonists (VKAs) with increased ease of use for stroke prevention in patients with atrial fibrillation (AF). In this study, we sought to evaluate the expectations, convenience, and satisfaction of Taiwanese AF patients on dabigatran and VKA therapies as well as associated clinical outcomes.
Patients with AF (paroxysmal, persistent, or permanent) receiving OAC medication from outpatient facilities were enrolled in 24 hospitals across Taiwan. Cohort A consisted of 139 patients switched from VKA to dabigatran, while cohort B was comprised of 1113 patients on newly initiated OAC therapy (VKA, 54). The Perception of Anticoagulant Treatment Questionnaire was distributed, and responses on a five-point Likert scale were aggregated and analyzed across demographic groups.
In cohort A, convenience and satisfaction scores continued to increase at follow-up and significantly higher, compared to baseline, but both treatments scored similarly in cohort B. In cohort B, the two highest expectation scores were that the OAC would be "easy to take" and could be "taken independently." On the other hand, the patients were relatively less concerned about the side effects and cost of therapy before taking the OAC. For dabigatran-receiving patients, there were 1.1 stroke-related events per 100 patient-years and 3.0 bleeding-related events per 100 patient-years.
In Taiwanese patients with AF and initially treated with VKA, switched to dabigatran resulted in higher convenience and treatment satisfaction. For those patients on newly initiated OAC treatment, VKA and dabigatran convenience and satisfaction scores were similar.
患者对口服抗凝剂 (OAC) 治疗的满意度是护理质量的一个重要指标，与更高的药物依从性有关。在 OAC 中，达比加群已被证明在预防房颤 (AF) 患者中风方面不劣于维生素 K 拮抗剂 (VKA)，且使用更为方便。在这项研究中，我们旨在评估台湾 AF 患者对达比加群和 VKA 治疗的期望、便利性和满意度，以及相关的临床结局。
从台湾 24 家医院的门诊设施中接受 OAC 药物治疗的 AF 患者入组本研究。队列 A 由 139 例从 VKA 转为达比加群的患者组成，队列 B 由 1113 例新开始 OAC 治疗（VKA，54 例）的患者组成。发放抗凝治疗认知问卷，根据五点 Likert 量表对各人口统计学组的应答进行汇总和分析。
在队列 A 中，便利性和满意度评分在随访时继续增加，且明显高于基线，但在队列 B 中，两种治疗方法的评分相似。在队列 B 中，患者对 OAC 的两个最高期望评分是“易于服用”和“可以独立服用”。另一方面，患者在开始服用 OAC 之前对治疗的副作用和费用相对不太关心。对于接受达比加群治疗的患者，每 100 患者年有 1.1 例与中风相关的事件和 3.0 例与出血相关的事件。
在台湾 AF 患者中，最初接受 VKA 治疗的患者转为达比加群后，便利性和治疗满意度更高。对于新开始 OAC 治疗的患者，VKA 和达比加群的便利性和满意度评分相似。
