Download PDF
Thromb Haemost 2018; 118(10): 1815-1822
DOI: 10.1055/s-0038-1670661
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Patient-Reported Treatment Satisfaction with Dabigatran versus Warfarin in Patients with Non-Valvular Atrial Fibrillation in China

Yan-Ping Geng
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
2   Department of Cardiology, Hebei General Hospital, Shijiazhuang, China
,
Di-Hui Lan
3   Department of Cardiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
,
Nian Liu
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
,
Xin Du
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
,
Danni Zheng
4   Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
,
Ri-Bo Tang
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
,
De-Yong Long
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
,
Rong-Hui Yu
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
,
Cai-Hua Sang
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
,
Rong Bai
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
,
Chen-Xi Jiang
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
,
Song-Nan Li
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
,
Xue-Yuan Guo
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
,
Wei Wang
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
,
Shi-Jun Xia
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
,
San-Shuai Chang
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
,
Jian-Zeng Dong
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
,
Ai-Hua Chen
3   Department of Cardiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
,
Chang-Sheng Ma
1   Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
› Author Affiliations Funding This work was supported by the National Key Research and Development Program of China (2016YFC0900901, 2016YFC1301002), a grant from the National Science Foundation of China (81530016) and grants from the Beijing Municipal Commission of Science and Technology (D151100002215003, D151100002215004). The construction of the China-AF was also supported by grants from BMS, Pfizer, Johnson & Johnson, BI and Bayer.
Further Information

Publication History

03 November 2017

08 August 2018

Publication Date:
20 September 2018 (online)

    Permissions and Reprints

Abstract

Background Anti-coagulant therapy satisfaction for patients with atrial fibrillation is a critical issue, which impacts on their treatment adherence and clinical outcomes. The disadvantages of long-term warfarin treatment are well-described, and novel oral anti-coagulants have become an alternative option.

Materials and Methods We compared patient-reported treatment satisfaction with dabigatran versus warfarin in non-valvular atrial fibrillation (NVAF) patients in China. Treatment satisfaction was assessed using the Anti-Clot Treatment Scale (ACTS) questionnaire, which included a 12-item ACTS Burdens scale and a 3-item ACTS Benefits scale.

Results Among 834 patients, 246 patients (29.5%) were taking dabigatran and the others were on warfarin. Propensity score matching was employed to identify 182 patient pairs with balanced baseline characteristics. The global ACTS Burdens score and the global ACTS Benefits score were comparable between the dabigatran and warfarin groups (44.86 ± 3.95 vs. 44.28 ± 3.51, p = 0.423; 11.49 ± 2.92 vs. 11.42 ± 3.03, p = 0.194, respectively). The monthly cost of dabigatran was significantly higher compared with that of warfarin due to a lack of insurance coverage (USD 176.78 ± 9.15 vs. USD 2.49 ± 0.76, p = 0.000). The discontinuation rate of dabigatran was significantly higher than warfarin at the 6-month follow-up (33.5% vs. 19.2%, p = 0.003). Adjusted logistic regression showed that dabigatran was associated with a significant greater odds of non-persistence (odds ratio: 2.13, 95% confidence interval: 1.27–3.59, p = 0.004).

Conclusion Dabigatran therapy in patients with NVAF in China associated with no improvement in satisfaction and a higher discontinuation rate compared with warfarin therapy largely due to increased economic burden.

Keywords

non-valvular atrial fibrillation - dabigatran - warfarin - anti-clot treatment scale - treatment satisfaction

Supplementary Material

 

  • References

  • 1 Ball J, Carrington MJ, McMurray JJ, Stewart S. Atrial fibrillation: profile and burden of an evolving epidemic in the 21st century. Int J Cardiol 2013; 167 (05) 1807-1824
    CrossrefPubMedGoogle Scholar
  • 2 Chugh SS, Havmoeller R, Narayanan K. , et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 2014; 129 (08) 837-847
    CrossrefPubMedGoogle Scholar
  • 3 Lip GY, Lane DA. Stroke prevention in atrial fibrillation: a systematic review. JAMA 2015; 313 (19) 1950-1962
    CrossrefPubMedGoogle Scholar
  • 4 Pirmohamed M, James S, Meakin S. , et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 2004; 329 (7456): 15-19
    CrossrefPubMedGoogle Scholar
  • 5 Wang Y, Kong MC, Lee LH, Ng HJ, Ko Y. Knowledge, satisfaction, and concerns regarding warfarin therapy and their association with warfarin adherence and anticoagulation control. Thromb Res 2014; 133 (04) 550-554
    CrossrefPubMedGoogle Scholar
  • 6 Wallentin L, Yusuf S, Ezekowitz MD. , et al; RE-LY investigators. Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial. Lancet 2010; 376 (9745): 975-983
    CrossrefPubMedGoogle Scholar
  • 7 Ntaios G, Papavasileiou V, Makaritsis K, Vemmos K, Michel P, Lip GYH. Real-world setting comparison of nonvitamin-K antagonist oral anticoagulants versus vitamin-K antagonists for stroke prevention in atrial fibrillation: a systematic review and meta-analysis. Stroke 2017; 48 (09) 2494-2503
    CrossrefPubMedGoogle Scholar
  • 8 Connolly SJ, Ezekowitz MD, Yusuf S. , et al; RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361 (12) 1139-1151
    CrossrefPubMedGoogle Scholar
  • 9 January CT, Wann LS, Alpert JS. , et al; ACC/AHA Task Force Members. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation 2014; 130 (23) e199-e267
    PubMedGoogle Scholar
  • 10 Kirchhof P, Benussi S, Kotecha D. , et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 2016; 18 (11) 1609-1678
    CrossrefPubMedGoogle Scholar
  • 11 Chang SS, Dong JZ, Ma CS. , et al. Current status and time trends of oral anticoagulation use among Chinese patients with nonvalvular atrial fibrillation: the Chinese Atrial Fibrillation Registry Study. Stroke 2016; 47 (07) 1803-1810
    CrossrefPubMedGoogle Scholar
  • 12 Oldgren J, Healey JS, Ezekowitz M. , et al; RE-LY Atrial Fibrillation Registry Investigators. Variations in cause and management of atrial fibrillation in a prospective registry of 15,400 emergency department patients in 46 countries: the RE-LY Atrial Fibrillation Registry. Circulation 2014; 129 (15) 1568-1576
    CrossrefPubMedGoogle Scholar
  • 13 Wang ZZ, Du X, Wang W. , et al. Long-term persistence of newly initiated warfarin therapy in Chinese patients with nonvalvular atrial fibrillation. Circ Cardiovasc Qual Outcomes 2016; 9 (04) 380-387
    CrossrefPubMedGoogle Scholar
  • 14 Hess PL, Mirro MJ, Diener HC. , et al; Atrial Fibrillation Think-Tank Participants. Addressing barriers to optimal oral anticoagulation use and persistence among patients with atrial fibrillation: proceedings, Washington, DC, December 3-4, 2012. Am Heart J 2014; 168 (03) 239-247
    CrossrefPubMedGoogle Scholar
  • 15 Pandya EY, Bajorek B. Factors affecting patients' perception on, and adherence to, anticoagulant therapy: anticipating the role of direct oral anticoagulants. Patient 2017; 10 (02) 163-185
    CrossrefPubMedGoogle Scholar
  • 16 Lane DA, Aguinaga L, Blomström-Lundqvist C. , et al. Cardiac tachyarrhythmias and patient values and preferences for their management: the European Heart Rhythm Association (EHRA) consensus document endorsed by the Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardíaca y Electrofisiología (SOLEACE). Europace 2015; 17 (12) 1747-1769
    CrossrefPubMedGoogle Scholar
  • 17 Cano SJ, Lamping DL, Bamber L, Smith S. The Anti-Clot Treatment Scale (ACTS) in clinical trials: cross-cultural validation in venous thromboembolism patients. Health Qual Life Outcomes 2012; 10: 120
    CrossrefPubMedGoogle Scholar
  • 18 Wild D, Murray M, Shakespeare A, Reaney M, von Maltzahn R. Patient-reported treatment satisfaction measures for long-term anticoagulant therapy. Expert Rev Pharmacoecon Outcomes Res 2008; 8 (03) 291-299
    CrossrefPubMedGoogle Scholar
  • 19 Suárez C, Pose A, Montero-Pérez-Barquero M. , et al; en representación del Grupo de Trabajo Comité Científico Estudio ALADIN. Validation of satisfaction questionnaire ACTS in outpatients with atrial fibrillation treated with oral anticoagulants in Spain. ALADIN Study [in Spanish]. Med Clin (Barc) 2016; 147 (05) 192-198
    CrossrefPubMedGoogle Scholar
  • 20 Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005; 353 (05) 487-497
    CrossrefPubMedGoogle Scholar
  • 21 Choi JC, Dibonaventura MD, Kopenhafer L, Nelson WW. Survey of the use of warfarin and the newer anticoagulant dabigatran in patients with atrial fibrillation. Patient Prefer Adherence 2014; 8: 167-177
    PubMedGoogle Scholar
  • 22 Contreras Muruaga MDM, Vivancos J, Reig G. , et al; ALADIN Study Investigators. Satisfaction, quality of life and perception of patients regarding burdens and benefits of vitamin K antagonists compared with direct oral anticoagulants in patients with nonvalvular atrial fibrillation. J Comp Eff Res 2017; 6 (04) 303-312
    CrossrefPubMedGoogle Scholar
  • 23 Bamber L, Wang MY, Prins MH. , et al. Patient-reported treatment satisfaction with oral rivaroxaban versus standard therapy in the treatment of acute symptomatic deep-vein thrombosis. Thromb Haemost 2013; 110 (04) 732-741
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Coleman CI, Haas S, Turpie AG. , et al; XANTUS Investigators. Impact of switching from a vitamin K antagonist to rivaroxaban on satisfaction with anticoagulation therapy: the XANTUS-ACTS substudy. Clin Cardiol 2016; 39 (10) 565-569
    CrossrefPubMedGoogle Scholar
  • 25 Prins MH, Bamber L, Cano SJ. , et al. Patient-reported treatment satisfaction with oral rivaroxaban versus standard therapy in the treatment of pulmonary embolism; results from the EINSTEIN PE trial. Thromb Res 2015; 135 (02) 281-288
    CrossrefPubMedGoogle Scholar
  • 26 Hanon O, Chaussade E, Gueranger P, Gruson E, Bonan S, Gay A. Patient-reported treatment satisfaction with rivaroxaban for stroke prevention in atrial fibrillation. A French observational study, the SAFARI Study. PLoS One 2016; 11 (12) e0166218
    CrossrefPubMedGoogle Scholar
  • 27 Schiavoni M, Margaglione M, Coluccia A. Use of dabigatran and rivaroxaban in non-valvular atrial fibrillation: one-year follow-up experience in an Italian centre. Blood Transfus 2018; 16 (02) 209-214
    PubMedGoogle Scholar
  • 28 Stangier J, Eriksson BI, Dahl OE. , et al. Pharmacokinetic profile of the oral direct thrombin inhibitor dabigatran etexilate in healthy volunteers and patients undergoing total hip replacement. J Clin Pharmacol 2005; 45 (05) 555-563
    CrossrefPubMedGoogle Scholar
  • 29 Coleman CI, Coleman SM, Vanderpoel J. , et al. Patient satisfaction with warfarin- and non-warfarin-containing thromboprophylaxis regimens for atrial fibrillation. J Investig Med 2013; 61 (05) 878-881
    CrossrefPubMedGoogle Scholar
  • 30 Lauffenburger JC, Farley JF, Gehi AK, Rhoney DH, Brookhart MA, Fang G. Factors driving anticoagulant selection in patients with atrial fibrillation in the United States. Am J Cardiol 2015; 115 (08) 1095-1101
    CrossrefPubMedGoogle Scholar
  • 31 Steinberg BA, Shrader P, Thomas L. , et al; Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Investigators and Patients. Factors associated with non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with new-onset atrial fibrillation: results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II (ORBIT-AF II). Am Heart J 2017; 189: 40-47
    CrossrefPubMedGoogle Scholar
  • 32 Ho MH, Ho CW, Cheung E. , et al. Continuation of dabigatran therapy in “real-world” practice in Hong Kong. PLoS One 2014; 9 (08) e101245
    CrossrefPubMedGoogle Scholar
  • 33 Vedovati MC, Verdecchia P, Giustozzi M. , et al. Permanent discontinuation of non vitamin K oral anticoagulants in real life patients with non-valvular atrial fibrillation. Int J Cardiol 2017; 236: 363-369
    CrossrefPubMedGoogle Scholar
  • 34 Beyer-Westendorf J, Ebertz F, Förster K. , et al. Effectiveness and safety of dabigatran therapy in daily-care patients with atrial fibrillation. Results from the Dresden NOAC Registry. Thromb Haemost 2015; 113 (06) 1247-1257
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Paquette M, Riou França L, Teutsch C. , et al. Persistence with dabigatran therapy at 2 years in patients with atrial fibrillation. J Am Coll Cardiol 2017; 70 (13) 1573-1583
    CrossrefPubMedGoogle Scholar
  • 36 Tsivgoulis G, Krogias C, Sands KA. , et al. Dabigatran etexilate for secondary stroke prevention: the first year experience from a multicenter short-term registry. Ther Adv Neurol Disorder 2014; 7 (03) 155-161
    PubMedGoogle Scholar
  • 37 Heeley E, Anderson CS, Huang Y. , et al; ChinaQUEST Investigators. Role of health insurance in averting economic hardship in families after acute stroke in China. Stroke 2009; 40 (06) 2149-2156
    CrossrefPubMedGoogle Scholar
  • 38 Fang MC, Go AS, Chang Y. , et al. Warfarin discontinuation after starting warfarin for atrial fibrillation. Circ Cardiovasc Qual Outcomes 2010; 3 (06) 624-631
    CrossrefPubMedGoogle Scholar