Patient and Physician Education Boosts Anticoagulant Adherence Rates

A recent global study has shown that educating patients about the anticoagulants they take results in a small reduced risk of stroke, coupled with an increased use of anticoagulation medications.

Only 58% of patients with atrial fibrillation worldwide take oral anticoagulant (OAC) drugs despite their effectiveness at preventing strokes, according to researchers at Duke Clinical Research Institute in Durham, NC, and five coordinating centers around the world.

The research, published in the August 28 issue of The Lancet and presented at the recent European Society of Cardiology meeting, found that a multifaceted education campaign aimed at physicians, patients, and families led to a 9% absolute increase in the use of OAC therapies.

Researchers also found a small but notable reduction in the risk of stroke, according to a statement from DukeHealth.

More than 2,200 patients at 48 hospitals in Argentina, Brazil, China, India, and Romania were enrolled in the study. The hospitals provided either standard care or a comprehensive educational effort - customized to each country - that explained the benefits and risks of OAC therapies to patients, their families, and physicians.

After patients were given brochures and shown videos, doctors asked them about their feedback and asked about problems that prevented them from taking or staying on the medication.

Physicians also received education on treatment of atrial fibrillation via articles and webinars. This was done because physicians’ decisions not to initiate OAC therapy in eligible patients is one of the main barriers for the effective use of antithrombotic therapy in atrial fibrillation, the researchers wrote.

“The need for frequent monitoring, medication costs, and lack of knowledge regarding the appropriate use of non-vitamin K antagonist OACs were all shown to be related to unwillingness to initiate and maintain OAC treatment in individual patients,” they said.

Among patients at centers that received the educational intervention, the use of OAC therapies rose by 11.7%, compared to a 2.6% rise in the non-intervention group. In addition, 48% of patients in the intervention group were on an anticoagulant after one year.

“If this intervention could be broadly applied, which we believe is possible, the public health implications would be

Christopher Granger, MDsubstantial,” said Christopher Granger, MD, Professor of Medicine at Duke and senior author of the study. Because more than 33 million people worldwide have atrial fibrillation, often leading to stroke, “adherence to anticoagulation therapy would be a lifesaver,” Granger added.

While the reduction in strokes was a secondary outcome of the study, it highlights the potential benefit of improved anticoagulation care, according to Renato Lopes, MD, PhD, Professor of Medicine at Duke and the principal investigator in Brazil.

The investigator-led study received funding from Boehringer Ingelheim Pharmaceuticals Inc., Daiichi Sankyo, Bayer Pharmaceuticals, Bristol-Myers Squibb, and Pfizer.