Knowledge about atrial fibrillation and anticoagulation affects the risk of clinical outcomes

Abstract

Background: Knowledge about atrial fibrillation (AF) and oral anticoagulation (OAC) is insufficient among AF patients.

Objective: We examined the association between this knowledge and event rate.

Methods: We studied 174 anticoagulated patients with AF aged 69±10.7 years (median CHA₂DS₂ -VASc 4). Knowledge was assessed at baseline using the Jessa AF Knowledge Questionnaire (JAKQ). The primary endpoint was a composite of ischemic cerebrovascular events, major or non-major clinically relevant bleeding, and death, recorded during a median follow-up of 42 months.

Results: The primary endpoint occurred in 48 (27.5%) patients (10.5 per 100 patient-years) including 12 ischemic cerebrovascular events (2.2 per 100 patient-years) and 29 bleeding episodes (5.8 per 100 patient- years). Lower baseline JAKQ scores were associated with the primary outcome (p=0.007), solely when patients who bled during follow-up were compared with the remainder (p=0.007). Patients who were aware of the importance of a regular anticoagulant intake despite the absence of AF symptoms, had, however, a lower risk of cerebrovascular events (p<0.0001). The subjects who experienced bleeding or the primary endpoint were less likely to understand the essence of AF (p=0.03), to know safe painkillers used in combination with OAC (p<0.001), and what to do when the anticoagulant was forgotten (p=0.02). Worse knowledge about AF and OAC, longer OAC therapy, and higher CHA₂DS₂ -VASc score were independent predictors for the primary endpoint.

Conclusions: Our study shows a prognostic value of low knowledge about AF and OAC supporting the need for improved education of AF patients.

Keywords: Anticoagulation; Atrial fibrillation; Bleeding.