Self-reported treatment burden: A comparison between vitamin K and non-vitamin K oral anticoagulants

Abstract

Introduction: Treatment burden (TBN) refers to the impact of patients' healthcare-related workload on their functioning and well-being. A high TBN has been associated with lower adherence to treatment and increased risk of major adverse events, and patients considered a TBN score of ≥59 points as unacceptably high. In the present analysis, we explored differences in TBN, the prevalence of unacceptably high TBN score and discern the contributory factors associated with TBN among patients receiving vitamin K oral anticoagulants (VKA) or non-vitamin K oral anticoagulants (NOAC). Methods: In a single-centre cross-sectional study from April to June 2019, consecutive patients receiving medical care at the Cardiology Clinic of University hospital were invited to fulfil the TBN Questionnaire encompassing 17 questions assessing TBN. Results: Of 514 study patients, 320 (62.3 %) were taking oral anticoagulant therapy (OAC) and were included in the present analysis. Of those, 206 patients (64.4 %) were prescribed a VKA. The mean TBN score was significantly higher in VKA versus NOAC patients (48.8 ± 26.5 vs. 41.8 ± 19.7, P = 0.014). Patients taking VKA reported a TBN of ≥59 points significantly more often than those taking NOAC (30.1 % vs 18.4 %, P = 0.024). The VKA patients reported significantly higher TBN score values for questions related to self-monitoring, including INR monitoring (3.85 ± 3.32 vs. 1.62 ± 1.38, P < 0.001) and diet restrictions (3.98 ± 3.43 vs. 2.48 ± 2.49, P < 0.001) compared with NOAC patients. Conclusion: In the present study, VKA patients reported significantly higher TBN and more frequently unacceptably high TBN compared to NOAC, primarily due to numerous VKA-food interactions and the need for regular INR monitoring. Our findings suggest that the prescription of NOAC could reduce the TBN, which could translate to improved patient outcomes.

Keywords

• Treatment burden
• Oral anticoagulation therapy
• Vitamin-K antagonist oral anticoagulant
• Non-vitamin K antagonist oral anticoagulants