Stroke Knowledge & OAC Preference in Patients with Atrial Fibrillation

Is there a link between stroke knowledge and OAC preferences in patients with AF? According to a new study, yes. 

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Clinical practice guidelines from the AHA/ACC/HRS and ESC recommend that patients with atrial fibrillation (AF) be involved in decisions about use of oral anticoagulants (OACs) for stroke prevention.1-4 Many studies, however, suggest understanding of AF is poor among these patients and that they know little about stroke, stroke risk, and OAC treatment.

The majority of stroke knowledge studies have been conducted in the general population and in populations with stroke risk factors other than AF. The current study by Lane and colleagues and published recently in Clinical Cardiology was designed to explore the relationship between stroke knowledge and OAC preferences specifically in patients with AF.

The results are essential knowledge for primary care physicians. 

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Largest Study of Stroke Knowledge/OAC Preferences. A cross-sectional study of 937 adults with nonvalvular AF on OACs for stroke prevention sought to assess the relationship between the patient's stroke knowledge and preferences for specific OAC attributes. Participants took a 30-minute online survey that asked about stroke knowledge, perception of AF and stroke, current Rx, and views on OACs. 

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More than 50% Have Low or No Stroke Knowledge. Stroke knowledge was "low" for 29.8% of participants and "good" for almost 20%. Overall, 39.4% of participants thought AF was very/extremely serious, yet less than half (47.5%) of those participants had "good" knowledge of stroke.

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Stroke Prevention was Most Important OAC Attribute for Patients with AF. Stroke prevention was ranked the most important OAC attribute (47.4% of patients) while the least important was whether the medication should be taken with or without food (4.8% of patients). The importance of stroke prevention with OACs also increased with increasing stroke knowledge. 

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Stroke Risk Reduction Most Important for Hypothetical OAC. There was no difference in preference by level of stroke knowledge, perception of seriousness of AF, concern for stroke, or medication burden. 

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Clinical Implications Include:

  • Among patients with AF, less than one-quarter (17.4%) named AF as a stroke risk factor
  • Underscores the need for improved patient education and provider-patient communication
  • Efficacy and safety of OACs considered most important by patients with AF
  • Dosing frequency is less important 
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Take Home Points Include:

  • Largest online survey of views about OACs among AF patients found stroke prevention and safety considered most important
  • >50% had low or no stroke knowledge and sizable percentage did not name AF as a stroke risk factor
  • Results highlight need for improved patient education and provider-patient communication 
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References 1. January CT, Wann LS, Alpert JS, et al. 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. J Am Coll Cardiol. 2014;64:e1–e76.2. Heidbuchel H, Verhamme P, Alings M, et al. Updated European Heart Rhythm Association practical guide on the use of non‐vitamin K antagonist anticoagulants in patients with non‐valvular atrial fibrillation. Europace. 2015;17:1467–1507.3. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37:2893–2962.4. Lane DA, Meyerhoff J, Rohner U, Lip GYH. Atrial fibrillation patient preferences for oral anticoagulation and stroke knowledge: Results of a conjoint analysis. Clin Cardiol. Published online April 25, 2018. DOI: 10.1002/clc.22971.