Atrial fibrillation DCE on oral anticoagulation treatment

Ingress health team members present at DGGOE (March 2015)  the results from a discrete choice experiment (DCE) comparing oral anticoagulation in patients with atrial fibrillation.

Since the introduction of the new oral anticoagulants (NOACs), a treatment alternative is available for vitamin K antagonists (VKA) for stroke prevention in atrial fibrillation (AF) patients. The aim of this study was to assess the treatment preferences of AF patients.

In a multicenter study, we randomly selected German physicians who selected patients treated with VKA or NOAC therapy. The preferences of the patients were assessed in computer-assisted telephone interviews. The final DCE questionnaire included four treatment related attributes (necessity of the Bridging anticoagulation in the case of surgery; Interactions with food; Necessity of INR Controls / dose adjustment; Frequency of daily intake) and one general attribute (Distance to the doctor). The results from the interviews were analyzed based on a logistic regression model.

A total of 493 AF patients were (age: 73.9 ± 8.2 years, 56.8% men, CHA2DS2-VASc: 3.7 ± 1.6; current medication: 47.6% Rivaroxaban, 51.8% VKA, 0.7% others) interviewed. Regardless of the type of medication, patients significantly preferred the attributes “daily intake” (Level: once / day = 1 vs. twice / day = 0; Coefficient = 0.607; p <0.001), “Bridging not necessary” (Bridging = 1 vs. no Bridging = 0; -0.551; p <0.001), “short distance to the doctor” (≤1 km = 1 vs.> 15 km = 0; 0.486; p <0.001), “no Interactions with food “(interaction = 1 vs. no interaction = 0; -0.331; p <0.001), and “no need of INR controls / dose adjustment” (Level: 1 vs. control = no controls = 0; -0.130; p <0.001).

Based on our findings it seems that patients with AF who take anticoagulants for stroke prevention prefer treatments that can be taken once daily, that require no bridging and have no food interactions.