Quality of Anticoagulation and Treatment Satisfaction in Patients with Non-Valvular Atrial Fibrillation Treated with Vitamin K Antagonist: Result from the KORean Atrial Fibrillation Investigation II

다국어 초록 (Multilingual Abstract)

Background: Vitamin K antagonist (VKA) to prevent thromboembolism in non-valvular atrial fibrillation (NVAF) patients has limitations such as drug interaction. This study investigated the clinical characteristics of Korean patients treated with VKA for stroke prevention and assessed quality of VKA therapy and treatment satisfaction.
Methods: We conducted a multicenter, prospective, non-interventional study. Patients with CHADS2 ≥ 1 and treated with VKA (started within the last 3 months) were enrolled from April 2013 to March 2014. Demographic and clinical features including risk factors of stroke and VKA treatment information was collected at baseline. Treatment patterns and international normalized ratio (INR) level were evaluated during follow-up. Time in therapeutic range (TTR) > 60% indicated well-controlled INR. Treatment satisfaction on the VKA use was measured by Treatment Satisfaction Questionnaire for Medication (TSQM) after 3 months of follow-up.
Results: A total of 877 patients (age, 67; male, 60%) were enrolled and followed up for one year. More than half of patients (56%) had CHADS2 ≥ 2 and 83.6% had CHA2DS2-VASc ≥ 2.
A total of 852 patients had one or more INR measurement during their follow-up period.
Among those patients, 25.5% discontinued VKA treatment during follow-up. Of all patients, 626 patients (73%) had poor-controlled INR (TTR < 60%) measure. Patients' treatment satisfaction measured with TSQM was 55.6 in global satisfaction domain.
Conclusion: INR was poorly controlled in Korean NVAF patients treated with VKA. VKA users also showed low treatment satisfaction.

참고문헌 (Reference)

1 Bungard TJ, "Why do patients with atrial fibrillation not receive warfarin?" 160 (160): 41-46, 2000

2 Oh S, "Vitamin K antagonist control in patients with atrial fibrillation in Asia compared with other regions of the world: real-world data from the GARFIELD-AF registry" 223 : 543-547, 2016

3 Ogilvie IM, "Underuse of oral anticoagulants in atrial fibrillation: a systematic review" 123 (123): 638-645, 2010

4 Newcombe RG, "Two-sided confidence intervals for the single proportion: comparison of seven methods" 17 (17): 857-872, 1998

5 신홍원, "Trends in Oral Anticoagulation Therapy Among Korean Patients With Atrial Fibrillation: The KORean Atrial Fibrillation Investigation" 대한심장학회 42 (42): 113-117, 2012

6 Fleiss JL, "Statistical Methods for Rates and Proportions" John Wiley & Sons, Inc 17-49, 2004

7 Sweileh WM, "Self-reported medication adherence and treatment satisfaction in patients with epilepsy" 21 (21): 301-305, 2011

8 Liberato AC, "Satisfaction with medication in coronary disease treatment: psychometrics of the treatment satisfaction questionnaire for medication" 24 : e2705-, 2016

9 Kakkar AK, "Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry" 8 (8): e63479-, 2013

10 Al-Jabi SW, "Relationship of treatment satisfaction to health-related quality of life: findings from a cross-sectional survey among hypertensive patients in Palestine" 18 (18): 3336-3348, 2015

11 Tulner LR, "Reasons for undertreatment with oral anticoagulants in frail geriatric outpatients with atrial fibrillation: a prospective, descriptive study" 27 (27): 39-50, 2010

12 Haas S, "Quality of vitamin K antagonist control and 1-year outcomes in patients with atrial fibrillation: a global perspective from the GARFIELD-AF registry" 11 (11): e0164076-, 2016

13 De Caterina R, "Quality of life and patient satisfaction in patients with atrial fibrillation on stable vitamin K antagonist treatment or switched to a non-vitamin K antagonist oral anticoagulant during a 1-year follow-up: a PREFER in AF registry substudy" 111 (111): 74-84, 2018

14 Go AS, "Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study" 285 (285): 2370-2375, 2001

15 Sudlow M, "Prevalence of atrial fibrillation and eligibility for anticoagulants in the community" 352 (352): 1167-1171, 1998

16 Jeong Joon Hoon, "Prevalence of and Risk Factors for Atrial Fibrillation in Korean Adults Older than 40 Years" 대한의학회 20 (20): 26-, 2005

17 Diringer MN, "Predictors of acute hospital costs for treatment of ischemic stroke in an academic center" 30 (30): 724-728, 1999

18 Reynolds MR, "Patterns and predictors of warfarin use in patients with new-onset atrial fibrillation from the FRACTAL Registry" 97 (97): 538-543, 2006

19 Dantas GC, "Patients' perspectives on taking warfarin: qualitative study in family practice" 5 (5): 15-, 2004

20 Wild D, "Patient perspectives on taking vitamin K antagonists: a qualitative study in the UK, USA and Spain" 9 (9): 467-474, 2009

21 Witt DM, "Outcomes and predictors of very stable INR control during chronic anticoagulation therapy" 114 (114): 952-956, 2009

22 Lip GY, "Oral anticoagulation in atrial fibrillation: A pan-European patient survey" 18 (18): 202-208, 2007

23 NCSS, "NCSS, LLC"

24 Slot KB, "Impact of functional status at six months on long term survival in patients with ischaemic stroke: prospective cohort studies" 336 (336): 376-379, 2008

25 Admassie E, "Changes in oral anticoagulant prescribing for stroke prevention in patients with atrial fibrillation" 120 (120): 1133-1138, 2017

26 Kim TH, "CHA2DS2-VASc score for identifying truly low-risk atrial fibrillation for stroke: a Korean nationwide cohort study" 48 (48): 2984-2990, 2017

27 Bajorek BV, "Balancing risk versus benefit: the elderly patient's perspective on warfarin therapy" 7 (7): 113-123, 2009

28 Dulli DA, "Atrial fibrillation is associated with severe acute ischemic stroke" 22 (22): 118-123, 2003

29 Marinigh R, "Age as a risk factor for stroke in atrial fibrillation patients: implications for thromboprophylaxis" 56 (56): 827-837, 2010

30 Lip GY, "A survey of atrial fibrillation in general practice: the West Birmingham Atrial Fibrillation Project" 47 (47): 285-289, 1997

31 Kirchhof P, "2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS" 37 (37): 2893-2962, 2016

32 January CT, "2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society" 130 (130): 2071-2104, 2014

33 January CT, "2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society" 64 (64): e1-e76, 2014