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Preferences for anticoagulation therapy in atrial fibrillation: the patients’ view

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.

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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.

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Correspondence to Thomas Wilke.

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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.

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Informed consent was obtained from all individual participants included in the study.

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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)

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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

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  • DOI: https://doi.org/10.1007/s11239-015-1263-x

Keywords

  • Atrial fibrillation
  • Patients’ preferences
  • Anticoagulation therapy
  • Discrete-choice design