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Deirdre Lane, Juliane Meyerhoff, Rohner Ute, Gregory YH Lip, 17-03: Effect of Age on Atrial Fibrillation Patient's Knowledge and Perceptions about Oral Anticoagulation Therapy: Results from an International Survey, EP Europace, Volume 18, Issue suppl_1, June 2016, Page i161, https://doi.org/10.1093/europace/18.suppl_1.i161b
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Abstract
Background: Stroke knowledge and perception of stroke risk are likely to affect oral anticoagulant (OAC) treatment preferences in patients with atrial fibrillation (AF). This international prospective study investigated the influence of age on patient perceptions of AF, stroke knowledge, preferences for oral anticoagulation (OAC) treatment decisions, and attributes of OAC affecting treatment choice.
Methods: Cross-sectional survey of 937 AF patients receiving OAC [overall mean (SD) age 54.3(16.6) years; 37.1% female; mean (SD) CHA2 DS2 -VASc score 2.6(1.7)] recruited from 5 countries (USA, Canada, Germany, Japan, France) in those aged <65 (n = 628) and ≥65 years (n = 309).
Results: Significantly fewer elderly patients had experienced a recent stroke and were less often concerned about stroke (Table). Good levels of stroke knowledge were higher in older AF patients (p < 0.001) and self-reported adherence to OAC was higher (p < 0.05). Stroke prevention was the most important factor when choosing OAC, particularly among older AF patients. Younger patients were more concerned by side effects other than major bleeding, dietary restrictions, and antidote availability when choosing OAC than older patients.
| Table . | Overall (n = 937) . | Age < 65 (n = 628) . | Age ≥ 65 (n = 309) . |
|---|---|---|---|
| Mean (SD) age, years | 54.3 (16.6) | 45.7 (13.1) | 71.7(5.7)** |
| Female | 37.1% | 37.6% | 36.2% |
| Mean CHA2 DS2 -VASc score (SD) | 2.6 (1.7) | 2.2 (1.6) | 3.6 (1.6)** |
| CHA2 DS2 -VASc ≥2 (female); ≥1 (male) | 85.0% | 87.5% | 100%** |
| Recent stroke | 20.7% | 23.9% | 14.2%** |
| Concern about stroke | |||
| Often/always | 43.4% | 49.4%** | 31.4%** |
| Occasionally | 45.4% | 42.0%** | 52.1%** |
| Never/I don't know | 11.2% | 8.6%** | 16.5%** |
| Knowledge of stroke | |||
| Good | 19.5% | 16.7% | 25.2%** |
| Moderate | 27.9% | 25.0% | 33.7%** |
| Low | 29.8% | 30.7% | 27.8% |
| None | 22.8% | 27.5% | 13.3%** |
| Self-reported adherence to OAC | |||
| Always take as prescribed | 79.9% | 77.7% | 84.4%* |
| Often take as prescribed | 17.4% | 19.3% | 13.6%* |
| Sometime take as prescribed | 2.4% | 2.7% | 1.6% |
| Rarely take as prescribed | 0.3% | 0.3% | 0.3% |
| Most important factor in choice of OAC | |||
| Stroke prevention | 47.4% | 41.9% | 58.6%** |
| Risk of major bleeding | 14.7% | 14.5% | 15.2% |
| Other side effects | 10.0% | 11.6% | 6.8%* |
| Dosing frequency | 8.2% | 7.6% | 9.4% |
| Antidote availability | 7.8% | 9.6% | 4.2%** |
| Dietary restrictions | 7.0% | 8.9% | 3.2%** |
| Take with/without food | 4.8% | 5.9% | 2.6%* |
| Table . | Overall (n = 937) . | Age < 65 (n = 628) . | Age ≥ 65 (n = 309) . |
|---|---|---|---|
| Mean (SD) age, years | 54.3 (16.6) | 45.7 (13.1) | 71.7(5.7)** |
| Female | 37.1% | 37.6% | 36.2% |
| Mean CHA2 DS2 -VASc score (SD) | 2.6 (1.7) | 2.2 (1.6) | 3.6 (1.6)** |
| CHA2 DS2 -VASc ≥2 (female); ≥1 (male) | 85.0% | 87.5% | 100%** |
| Recent stroke | 20.7% | 23.9% | 14.2%** |
| Concern about stroke | |||
| Often/always | 43.4% | 49.4%** | 31.4%** |
| Occasionally | 45.4% | 42.0%** | 52.1%** |
| Never/I don't know | 11.2% | 8.6%** | 16.5%** |
| Knowledge of stroke | |||
| Good | 19.5% | 16.7% | 25.2%** |
| Moderate | 27.9% | 25.0% | 33.7%** |
| Low | 29.8% | 30.7% | 27.8% |
| None | 22.8% | 27.5% | 13.3%** |
| Self-reported adherence to OAC | |||
| Always take as prescribed | 79.9% | 77.7% | 84.4%* |
| Often take as prescribed | 17.4% | 19.3% | 13.6%* |
| Sometime take as prescribed | 2.4% | 2.7% | 1.6% |
| Rarely take as prescribed | 0.3% | 0.3% | 0.3% |
| Most important factor in choice of OAC | |||
| Stroke prevention | 47.4% | 41.9% | 58.6%** |
| Risk of major bleeding | 14.7% | 14.5% | 15.2% |
| Other side effects | 10.0% | 11.6% | 6.8%* |
| Dosing frequency | 8.2% | 7.6% | 9.4% |
| Antidote availability | 7.8% | 9.6% | 4.2%** |
| Dietary restrictions | 7.0% | 8.9% | 3.2%** |
| Take with/without food | 4.8% | 5.9% | 2.6%* |
*p < 0.05; **p < 0.001 vs. patients <65 years
| Table . | Overall (n = 937) . | Age < 65 (n = 628) . | Age ≥ 65 (n = 309) . |
|---|---|---|---|
| Mean (SD) age, years | 54.3 (16.6) | 45.7 (13.1) | 71.7(5.7)** |
| Female | 37.1% | 37.6% | 36.2% |
| Mean CHA2 DS2 -VASc score (SD) | 2.6 (1.7) | 2.2 (1.6) | 3.6 (1.6)** |
| CHA2 DS2 -VASc ≥2 (female); ≥1 (male) | 85.0% | 87.5% | 100%** |
| Recent stroke | 20.7% | 23.9% | 14.2%** |
| Concern about stroke | |||
| Often/always | 43.4% | 49.4%** | 31.4%** |
| Occasionally | 45.4% | 42.0%** | 52.1%** |
| Never/I don't know | 11.2% | 8.6%** | 16.5%** |
| Knowledge of stroke | |||
| Good | 19.5% | 16.7% | 25.2%** |
| Moderate | 27.9% | 25.0% | 33.7%** |
| Low | 29.8% | 30.7% | 27.8% |
| None | 22.8% | 27.5% | 13.3%** |
| Self-reported adherence to OAC | |||
| Always take as prescribed | 79.9% | 77.7% | 84.4%* |
| Often take as prescribed | 17.4% | 19.3% | 13.6%* |
| Sometime take as prescribed | 2.4% | 2.7% | 1.6% |
| Rarely take as prescribed | 0.3% | 0.3% | 0.3% |
| Most important factor in choice of OAC | |||
| Stroke prevention | 47.4% | 41.9% | 58.6%** |
| Risk of major bleeding | 14.7% | 14.5% | 15.2% |
| Other side effects | 10.0% | 11.6% | 6.8%* |
| Dosing frequency | 8.2% | 7.6% | 9.4% |
| Antidote availability | 7.8% | 9.6% | 4.2%** |
| Dietary restrictions | 7.0% | 8.9% | 3.2%** |
| Take with/without food | 4.8% | 5.9% | 2.6%* |
| Table . | Overall (n = 937) . | Age < 65 (n = 628) . | Age ≥ 65 (n = 309) . |
|---|---|---|---|
| Mean (SD) age, years | 54.3 (16.6) | 45.7 (13.1) | 71.7(5.7)** |
| Female | 37.1% | 37.6% | 36.2% |
| Mean CHA2 DS2 -VASc score (SD) | 2.6 (1.7) | 2.2 (1.6) | 3.6 (1.6)** |
| CHA2 DS2 -VASc ≥2 (female); ≥1 (male) | 85.0% | 87.5% | 100%** |
| Recent stroke | 20.7% | 23.9% | 14.2%** |
| Concern about stroke | |||
| Often/always | 43.4% | 49.4%** | 31.4%** |
| Occasionally | 45.4% | 42.0%** | 52.1%** |
| Never/I don't know | 11.2% | 8.6%** | 16.5%** |
| Knowledge of stroke | |||
| Good | 19.5% | 16.7% | 25.2%** |
| Moderate | 27.9% | 25.0% | 33.7%** |
| Low | 29.8% | 30.7% | 27.8% |
| None | 22.8% | 27.5% | 13.3%** |
| Self-reported adherence to OAC | |||
| Always take as prescribed | 79.9% | 77.7% | 84.4%* |
| Often take as prescribed | 17.4% | 19.3% | 13.6%* |
| Sometime take as prescribed | 2.4% | 2.7% | 1.6% |
| Rarely take as prescribed | 0.3% | 0.3% | 0.3% |
| Most important factor in choice of OAC | |||
| Stroke prevention | 47.4% | 41.9% | 58.6%** |
| Risk of major bleeding | 14.7% | 14.5% | 15.2% |
| Other side effects | 10.0% | 11.6% | 6.8%* |
| Dosing frequency | 8.2% | 7.6% | 9.4% |
| Antidote availability | 7.8% | 9.6% | 4.2%** |
| Dietary restrictions | 7.0% | 8.9% | 3.2%** |
| Take with/without food | 4.8% | 5.9% | 2.6%* |
*p < 0.05; **p < 0.001 vs. patients <65 years
Conclusion: Younger AF patients were more concerned about stroke but had poorer stroke knowledge, and reported lower adherence to OAC. Stroke prevention is the most important factor when choosing OAC, regardless of age, with younger patients more concerned about side effects, antidote availability and dietary restrictions.
Conflict of interest: Investigator-initiated educational grants from Bayer Healthcare, Bristol Myers Squibb (BMS) and Boehringer Ingelheim Speaker Bureau for Boehringer Ingelheim, Bayer, and BMS/Pfizer Consultant for BMS and Boehringer Ingelheim
