Quality-of-Life Scores Normal on Vitamin K Antagonist Anticoagulation for Atrial Fibrillation

Veronica Hackethal, MD

June 23, 2016

GRONINGEN, THE NETHERLANDS — In the face of common perceptions that patients consider the rigors vitamin K antagonist (VKA) treatment to be a burden, a new study suggests that VKA users with atrial fibrillation (AF) have a quality of life similar to the general population[1]. Results were published online on June 21, 2016 in Circulation: Cardiovascular Quality Outcomes.

"Our data provided more insight in the perception of VKA treatment and showed that VKA did not negatively influence general quality of life after 3 months of use. Possibly, this can help to persuade the large group of AF patients who are at risk for stroke but are afraid to start VKA treatment," write the authors, led by Dr Hilde AM Kooistra (University Medical Center Groningen, the Netherlands).

Warfarin and other VKAs are long-established in patients with AF as highly effective in preventing stroke. However, their need for anticoagulation monitoring, sometimes complex dosing, and dietary restrictions along with a risk of bleeding have been cited as disadvantages in support of the more recent direct oral anticoagulants. But data on whether they have an effect on quality of life has been inconsistent, according to the group.

Their study, conducted from March to August 2013 at a major medical center's outpatient thrombosis clinic, included 807 VKA users: 240 new users and 567 on the agents for 6 months or more. Researchers assessed patients' general quality of life and perception of VKAs, including satisfaction and convenience, at baseline and 3 months. Questionnaire responses were scored on a 100-point scale, with higher scores indicating improvement. Results were compared with responses to the same questionnaire completed by 1742 participants in the Netherlands Organization for Applied Scientific Research in 1996, who represented the country's general population.

New VKA Users

Quality-of-life scores among new VKA users were similar those of the control cohort by the end of 3 months, averaging 95.

Older patients had higher scores (regression coefficient 0.47 per year; 95% CI 0.25–0.69), while patients younger than 65 who experienced bleeding had lower scores (regression coefficient −12; 95% CI −20 to −4.7).

New patients had a median satisfaction score of 64, with no correlation to patient and treatment characteristics. Most patients reported no difficulties (79%) or few difficulties (18%) with dose adjustments and no (74%) or few difficulties (21%) with follow-up appointments.

Long-term VKA Users

Long-term users had perception scores that were comparable to those of new patients, according to the group. Their median convenience score of 96 and a median satisfaction score of 64 was almost unchanged between the first and second questionnaires.

Time in the therapeutic range was the only factor significantly associated with convenience score; the two rose in tandem (regression coefficient 0.03; 95% CI 0.01–0.05; r2=0.01).

Satisfaction scores declined with introduction of a new comedication, which was the only significant influencer of those scores (regression coefficient −7.0; 95% CI −12 to −1.9; r2=0.02). Most reported no or few difficulties for follow-up appointments (98%) and dose adjustments (97%).


The authors noted that study participation may not have been random, and the study did not include patients who refused VKA therapy, the group notes.

The high convenience scores suggest that further improvements in convenience are unlikely from switching to aspirin or non-VKA oral anticoagulants, they add.

"This study also demonstrated no or very limited impact of the regular visits that characterize VKA on patients' well-being," they added, "To achieve better adherence, instead of decreasing the number of visits, it would probably be more effective to inform patients on the good tolerability of VKA."

Kooistra reports travel support from Bayer Healthcare, outside the submitted work. Disclosures for the coauthors are listed in the article.

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