Abstract
Since the introduction of new oral anticoagulants (NOACs), besides vitamin-K antagonists, an additional option for stroke prevention of patients with atrial fibrillation (AF) is available. The objective of this study was to assess AF patients’ preferences with regard to the attributes of these different treatment options. We conducted a multicenter study among randomly selected physicians. Preferences were assessed by computer-assisted telephone interviews. We used a discrete-choice-experiment (DCE) with four convenience-related treatment dependent attributes (need of bridging: yes/no, interactions with food/nutrition: yes/no, need of INR controls/dose adjustment: yes/no; frequency of intake: once/twice daily) and one comparator attribute (distance to practitioner: <1 km/>15 km). Preferences measured in the interviews were analyzed descriptively and based on a conditional logit regression model. A total of 486 AF patients (age: 73.9 ± 8.2 years; 43.2 % female; mean CHA2DS2-VASc: 3.7 ± 1.6; current medication: 48.1 % rivaroxaban, 51.9 % VKA) could be interviewed. Regardless of type of medication, patients significantly preferred the attribute levels (in order of patients’ importance) “once daily intake” (Level: once = 1 vs. twice = 0; Coefficient = 0.615; p < 0.001), “bridging necessary” (yes = 1 vs. no = 0; −0.558; p < 0.001), “distance to practitioner of ≤1 km (>15 km = 0 vs. ≤1 km = 1; 0.494; p < 0.001), “interactions with food/nutrition” (yes = 1 vs. no = 0; −0.332; p < 0.001) and “need of INR controls/dose adjustment” (yes = 1 vs. no = 0; −0.127; p < 0.001). In our analyses, “once daily frequency of intake” was the most important OAC-attribute for patients’ choice followed by “no bridging necessary” and “no interactions with food/nutrition”. Thus, patients with AF seem to prefer treatment options which are easier to administer.
Similar content being viewed by others
References
Ryder KM, Benjamin EJ (1999) Epidemiology and significance of atrial fibrillation. Am J Cardiol 84(9A):131R–138R
Chugh SS, Blackshear JL, Shen WK et al (2001) Epidemiology and natural history of atrial fibrillation: clinical implications. J Am Coll Cardiol 37(2):371–378
Chien KL, Su TC, Hsu HC et al (2010) Atrial fibrillation prevalence, incidence and risk of stroke and all-cause death among Chinese. Int J Cardiol 139(2):173–180
Fang MC, Go AS, Chang Y et al (2008) ATRIA Study Group. Comparison of risk stratification schemes to predict thromboembolism in people with nonvalvular atrial fibrillation. J Am Coll Cardiol 51(8):810–815
Wilke T, Groth A, Mueller S et al (2013) Incidence and prevalence of atrial fibrillation: an analysis based on 8.3 million patients. Europace 15(4):486–493
Davis RC, Hobbs FD, Kenkre JE et al (2012) Prevalence of atrial fibrillation in the general population and in high-risk groups: the ECHOES study. Europace 14:1553–1559
Camm AJ, Kirchhof P, Lip GY et al (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31:2369–2429
Kirchhof P, Auricchio A, Bax J et al (2007) Outcome parameters for trials in atrial fibrillation: executive summary. Recommendations from a consensus conference organized by the German Atrial Fibrillation Competence NETwork (AFNET) and the European Heart Rhythm Association (EHRA). Eur Heart J 28:2803–2817
Stewart S, Hart CL, Hole DJ et al (2002) A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med 113:359–364
Friberg L, Hammar N, Rosenqvist M (2010) Stroke in paroxysmal atrial fibrillation: report from the Stockholm Cohort of Atrial Fibrillation. Eur Heart J 31:967–975
Halperin JL, Kay GN, Le Huezey JY et al (2011) ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123:e269–e367
Gage BF, Waterman AD, Shannon W et al (2001) Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 285(22):2864–2870
Lip GY, Nieuwlaat R, Pisters R et al (2010) Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest 137:263–272
Fumagalli S, Cardini F, Roberts AT et al (2014) Psychological effects of treatment with new oral anticoagulants in elderly patients with atrial fibrillation: a preliminary report. Aging Clin Exp Res
Ogilvie IM, Newton N, Welner SA et al (2010) Underuse of oral anticoagulants in atrial fibrillation: a systematic review. Am J Med 123(7):638–645
Wilke T, Groth A, Pfannkuche M et al (2014) Real life anticoagulation treatment of patients with atrial fibrillation in Germany: extent and causes of anticoagulant under-use. J Thromb Thrombol
Wilke T, Groth A, Mueller S et al (2012) Oral anticoagulation use by patients with atrial fibrillation in Germany. Adherence to guidelines, causes of anticoagulation under-use and its clinical outcomes, based on claims-data of 183,448 patients. Thromb Haemost 107(6):1053–1065
Connolly SJ, Ezekowitz MD, Yusuf S et al (2009) Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 361(12):1139–1151
Patel MR, Mahaffey KW, Garg J et al (2011) Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 365(10):883–891
Granger CB, Alexander JH, McMurray JJ et al (2011) Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 365(11):981–992
Ghijben P, Lancsar E, Zavarsek S (2014) Preferences for oral anticoagulants in atrial fibrillation: a best-best discrete choice experiment. Pharmacoeconomics 32(11):1115–1127
Bakhai A, Sandberg A, Mittendorf T et al (2013) Patient perspective on the management of atrial fibrillation in five European countries. BMC Cardiovasc Disord 13:108
Jones C, Pollit V, Fitzmaurice D et al (2014) The management of atrial fibrillation: summary of updated NICE guidance. BMJ 348:g3655
Man-Son-Hing M, Gage BF, Montgomery AA et al (2005) Preference-based antithrombotic therapy in atrial fibrillation: implications for clinical decision making. Med Decis Making 25(5):548–559
Gage BF, Cardinalli AB, Owens DK (1998) Cost-effectiveness of preference-based antithrombotic therapy for patients with nonvalvular atrial fibrillation. Stroke 29(6):1083–1091
Protheroe J, Fahey T, Montgomery AA et al (2000) The impact of patients’ preferences on the treatment of atrial fibrillation: observational study of patient based decision analysis. BMJ 320(7246):1380–1384
Johnson RF, Orme BK (2010) Sample size issues for conjoint analysis. Orme BK, Getting started with conjoint analysis: strategies for product design and pricing research. Research Publishers, Madison, pp 57–66
Ware JE, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233
Clark MD, Determann D, Petrou S et al (2014) Discrete choice experiments in health economics: a review of the literature. Pharmacoeconomics 32(9):883–902
Reed Johnson F, Lancsar E, Marshall D et al (2013) Constructing experimental designs for discrete-choice experiments: report of the ISPOR Conjoint Analysis Experimental Design Good Research Practices Task Force. Value Health 16(1):3–13
Hoffmann-La Roche AG (2004) Summary of product characteristics (SmPC) of Marcumar. https://www.klinikum.uni-heidelberg.de/fileadmin/medizinische_klinik/Abteilung_3/pdf/ivandic/FI_marcumar.pdf. Accessed 14 October 2013
Bayer Pharma AG (2011) Summary of product characteristics (SmPC) of Xarelto. http://www.coliquio.de/images/infocenter/upload/xarelto/Fachinfo_Xarelto_20_mg_Filmtabletten.pdf. Accessed 14 October 2013
MacLean S, Mulla S, Akl EA et al (2012) Patient values and preferences in decision making for antithrombotic therapy: a systematic review: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e1S–e23S
Moia M, Mantovani LG, Carpenedo M et al (2013) Patient preferences and willingness to pay for different options of anticoagulant therapy. Intern Emerg Med 8(3):237–243
Borg Xuereb C, Shaw RL, Lane DA (2012) Patients’ and health professionals’ views and experiences of atrial fibrillation and oral-anticoagulant therapy: a qualitative meta-synthesis. Patient Educ Couns 88(2):330–337
Coleman CI, Roberts MS, Sobieraj DM et al (2012) Effect of dosing frequency on chronic cardiovascular disease medication adherence. Curr Med Res Opin 28(5):669–680
Choi JC, Dibonaventura MD, Kopenhafer L et al (2014) Survey of the use of warfarin and the newer anticoagulant dabigatran in patients with atrial fibrillation. Patient Prefer Adherence 8:167–177
Palacio AM, Kirolos I, Tamariz L (2015) Patient values and preferences when choosing anticoagulants. Patient Prefer Adherence 9:133–138
Acknowledgments
This study was financed by Bayer Vital GmbH, Germany.
Disclosure
Björn Böttger worked for IPAM until 31st of March 2015. Prof. Dr. Thomas Wilke has acted as consultant for different pharmaceutical companies, e.g. Novo Nordisk, Glaxo Smith Kline, Bayer, Bristol-Myers Squibb, Sanofi-Aventis. Dr. Inga-Marion Thate Waschke works for Bayer Vital GmbH, Germany. Prof. Dr. Rupert Bauersachs has acted as consultant for Boehringer Ingelheim Pharma, Bayer and Bristol-Myers Squibb. Prof. Dr. Thomas Kohlmann received consultancy fees, project funding and reimbursement of travel costs from different pharmaceutical companies, e.g. Bayer, Hexal, Lilly, Pfizer, Sanofi-Aventis.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Statement of human rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Electronic supplementary material
Below is the link to the electronic supplementary material.
11239_2015_1263_MOESM1_ESM.pdf
Content of the conducted computer assisted phone interview: interviews were done in German; here an English translation is provided (PDF 359 kb)
Rights and permissions
About this article
Cite this article
Böttger, B., Thate-Waschke, IM., Bauersachs, R. et al. Preferences for anticoagulation therapy in atrial fibrillation: the patients’ view. J Thromb Thrombolysis 40, 406–415 (2015). https://doi.org/10.1007/s11239-015-1263-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11239-015-1263-x