Quality of Life and Treatment Satisfaction Among Patients on Long Term Oral Anticoagulant in A Developing Country

• Main Authors: Tan, K.L., Ng, Diana Leh-Ching, Gan, G.G., Chai, C.S., Chee, K.H.
• Format: E-Article
• Language: English
• Published: Elsevier 2019
• Subjects: R Medicine (General); RZ Other systems of medicine
• Online Access: http://ir.unimas.my/id/eprint/30773/1/Cardio.pdf; http://ir.unimas.my/id/eprint/30773/; https://doi.org/10.1016/j.ijcard.2019.11.037

Background: Randomised phase III studies had proven the efficacy and safety profile of direct oral anticoagulant (DOAC) over warfarin in stroke and systemic embolism prevention for patients with atrial fibrillation (AF) and venous thromboembolism (VTE). Nevertheless, patients’ quality of life (QOL) and treatment satisfaction was not explored in these studies. Objective: The primary objective of this study was to compare the QOL and treatment satisfaction of patients on long term warfarin versus DOACs in a tertiary hospital in Malaysia. Methods: This is a cross-sectional study of patients with nonvalvular AF (NVAF) or VTE on long term warfarin versus DOACs attending the cardiology clinic and anticoagulation clinic of University Malaya Medical Centre from 1 st July 2016 to 30 st June 2018. Patients’ QOL was assessed by using Short Form 12v2 Health Survey (SF12v2); while treatment satisfaction was assessed by using Perception of Anticoagulation Treatment Questionnaire 2 (PACT-Q2). Results: Of 208 patients, 52.4% received warfarin and remaining 47.6% received DOACs. The warfarin group was significantly younger and had longer treatment duration (p b 0.001); while DOAC group had significant more underlying NVAF (p b 0.001) and polypharmacy (p= 0.003). There was no significant difference in the score of physical component summary (PCS) (p= 0.083), mental component summary (MCS) (p = 0.665) and each domain of SF-12v12 (p = 0.058 – 0.953) between anticoagulant groups. There were no differences between the 2 groups of anticoagulants even after adjustment of age. The satisfactionscore was significant higher in DOACs group compared to warfarin group (p = 0.003); but there was no difference in the convenience score (p= 0.234). Hospitalisation rate was significantly higher (p = 0.002) in warfarin group. Only 45.0% of patients achieved good time in therapeutic range (TTR). Conclusions: Despite no significant difference in QOL, patients with AF or VTE who were treated with DOACs demonstrated better efficacy, safety, and satisfaction profile, as well as a relatively stable within-group QOL.