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The Patient - Patient-Centered Outcomes Research
Published in: The Patient - Patient-Centered Outcomes Research 1/2017

Open Access 01-02-2017 | Systematic Review

Patient Preferences for Oral Anticoagulation Therapy in Atrial Fibrillation: A Systematic Literature Review

Authors: Thomas Wilke, Sabine Bauer, Sabrina Mueller, Thomas Kohlmann, Rupert Bauersachs

Published in: The Patient - Patient-Centered Outcomes Research | Issue 1/2017

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Abstract

Objectives

Since the introduction of non-vitamin K antagonist (VKA) oral anticoagulants (NOACs), an additional treatment option, apart from VKAs, has become available for stroke prevention in patients with atrial fibrillation (AF). For various reasons, it is important to consider patients’ preferences regarding type of medication, particularly in view of the established relationship between preferences towards treatment, associated burden of treatment, and treatment adherence. This review aimed to systematically analyse the scientific literature assessing the preferences of AF patients with regard to long-term oral anticoagulant (OAC) treatment.

Methods

We searched the MEDLINE, Scopus and EMBASE databases (from 1980 to 2015), added records from reference lists of publications found, and conducted a systematic review based on all identified publications. Outcomes of interest included any quantitative information regarding the opinions or preferences of AF patients towards OAC treatment, ideally specified according to different clinical or convenience attributes describing different OAC treatment options.

Results

Overall, 27 publications describing the results of studies conducted in 12 different countries were included in our review. Among these, 16 studies analysed patient preferences towards OACs in general. These studies predominantly assessed which benefits (mainly lower stroke risk) AF patients would require to tolerate harms (mainly higher bleeding risk) associated with an OAC. Most studies showed that patients were willing to accept higher bleeding risks if a certain threshold in stroke risk reduction could be reached. Nevertheless, most of the publications also showed that the preferences of AF patients towards OACs may differ from the perspective of clinical guidelines or the perspective of physicians. The remaining 11 studies included in our review assessed the preferences of AF patients towards specific OAC medication options, namely NOACs versus VKAs. Our review showed that AF patients prefer easy-to-administer treatments, such as treatments that are applied once daily without any food/drug interactions and without the need for bridging and frequent blood controls.

Conclusion

Stroke risk reduction and a moderate increase in the risk of bleeding are the most important attributes for an AF patient when deciding whether they are for or against OAC treatment. If different anticoagulation options have similar clinical characteristics, convenience attributes matter to patients. In this review, AF patients favour attribute levels that describe NOAC treatment.
Footnotes
1
Search strings entered in MEDLINE were ‘discrete AND choice AND experiment AND atrial AND fibrillation’, ‘discrete AND choice AND experiment AND anticoagulation’, ‘treatment AND preferences AND atrial AND fibrillation’, ‘treatment AND preferences AND atrial AND fibrillation’, ‘discrete AND choice AND experiment AND af’, ‘discrete AND choice AND experiment AND ac’, ‘dce AND atrial fibrillation’, ‘dce AND anticoagulation’, ‘discrete AND choice AND experiment AND cardiac AND arrhythmia’, ‘treatment AND preference AND cardiac AND arrhythmia’, ‘treatment AND preferences AND cardiac AND arrhythmia’, ‘anticoagulant AND discrete AND choice’, ‘anticoagulant AND patient AND preference’, ‘discrete AND choice AND anticoagulation’, ‘discrete AND choice AND anticoagulant’, ‘conjoint AND preference AND anticoagulation’, ‘trade off AND preference AND anticoagulation’, ‘preference AND atrial fibrillation’, ‘preference AND anticoagulation’, ‘preference AND anticoagulant’.
 
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Metadata
Title
Patient Preferences for Oral Anticoagulation Therapy in Atrial Fibrillation: A Systematic Literature Review
Authors
Thomas Wilke
Sabine Bauer
Sabrina Mueller
Thomas Kohlmann
Rupert Bauersachs
Publication date
01-02-2017
Publisher
Springer International Publishing
Published in
The Patient - Patient-Centered Outcomes Research / Issue 1/2017
Print ISSN: 1178-1653
Electronic ISSN: 1178-1661
DOI
https://doi.org/10.1007/s40271-016-0185-9

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