Patients’ education plays part in how they manage anticoagulants

The educational background of patients with atrial fibrillation (AF) directly influences how they manage their anticoagulation, according to research. 

Writing their findings in Europace^[1]
(online, 21 February 2016), researchers found that patients with no schooling were more likely to miss treatment targets, were less aware of bleeding risks and unaware that they can continue normal daily activities, compared with patients who went to college and/or university. 

Some 1,147 patients with AF were recruited from eight European countries to complete a 40-question online survey as part of the research. The average age of the cohort was 66 years. All patients were taking anticoagulants to treat their condition – typically vitamin K antagonists such as warfarin or non-vitamin K oral anticoagulants (NOACs). 

Patients taking vitamin K antagonists have to regulate their international normalised ratio (INR) – which indicates how long it takes blood to form a clot – to between two and three as part of their treatment. The survey found that those with no schooling were more likely to exceed their upper INR limit several times a month compared to their peers who were college or university educated (5.1% versus 2.8%, P<0.05). 

“This survey provides some insights into the current patient’s knowledge, education, and compliance regarding oral anticoagulation therapy,” the researchers conclude. “The differences in the educational level may compromise the safety and efficacy of anticoagulants.”

They say the results of the survey show that there is still a place for improvement of education and compliance among patients on oral anticoagulation. “Education of AF patients should be reinforced to improve anticoagulation in clinical practice. Of particular interest, there is a need of education for patients taking NOACs.” 

Knowledge of risk of bleeding was lowest in patients without schooling and highest in those with college and university education (38.5% versus 57.0%, P<0.05). The same pattern was reflected in patients taking NOACs. Patients without schooling reported the highest rate of bleeding while taking anticoagulants, and the highest rate of previous stroke (2.6% compared with 0.7% in those with college and university education, P<0.05). 

Some 20.5% of those without schooling (P<0.05) were aware about NOACS (compared with 56.5% of those with a university education) – figures described as “relatively low” by the researchers. 

They found 15.3% of patients without schooling were unaware that blood tests were not necessary for NOACs, while 2.5% of this patient group knew that NOACs were as effective as warfarin in controlling their condition compared to 25% of patients with trade/technical education, and up to 42.4% of patients with university education (P<0.05). 

The majority of survey participants (91–94%) knew the purpose of anticoagulants was to “thin the blood”, but the remaining 6–9% thought it was to control the arrhythmia. Education background was not a factor in their thinking. The survey also found that those patients with a higher level of education more frequently managed their own dosing compared with patients who received no schooling (21.9% versus 12.9%, P<0.05). 

In terms of adherence to therapy, 28.7% of men and 24.5% of women (P<0.05) reported that they forgot to take their anticoagulants occasionally. It was found that younger patients were more likely to forget their medication than patients over the age of 65 years (31.3% vs 24%, P<0.05).

Some 80.2% of patients with university education understood that they could continue their normal daily activities compared to 51.8% (P < 0.05) of those patients with no schooling.

Commenting on the findings, Sotiris Antoniou, consultant pharmacist in cardiovascular medicine at Barts Health NHS Trust in London, says: “We know that certain characteristics that have been shown to predict non-compliance include intelligence and level of education, income and socio-demographics, however the findings tend to be inconsistent.

“What this survey reiterates to us is that all health care professionals including pharmacists need to adapt the consultation to suit the individual and be at a level that the person understands the information,” he adds. 

“We can then ensure that treatment fits in with the individual patient’s routine, meet their expectations and preferences as well as address any concerns the individual may have around taking their medication to support ongoing long term adherence to therapy.”