Patient knowledge and perceptions of atrial fibrillation and anticoagulant therapy: Effects of an educational intervention programme

Abstract

Objective

Previous research has demonstrated that patients with atrial fibrillation (AF) possess very little knowledge of their disease, the consequences of AF and the benefits/risks of anti-coagulant therapy. The aim of this pilot study was to examine patient's knowledge and perceptions of AF and their anticoagulant treatment before and after a brief educational intervention.

Materials and methods

Ninety-three patients (47 male; mean (S.D.) age 67.3 (11.6) years) completed the baseline interview to assess their knowledge and perceptions of AF. All patients were given an information booklet which explained what AF was, associated symptoms, the possible causes and consequences of AF, treatment options and their benefits/risks, what the INR is and what factors may effect it. The booklet was explained to each patient by the researcher and given to the patient to take away for reference. Thirty-three (35.5%) patients (12 men; mean (S.D.) age 68.0 (13.6) years) completed the follow-up assessment to re-assess their knowledge and perceptions of AF.

Results

Only 49% of patients could name their cardiac condition at baseline, although the majority were aware that AF was an arrhythmia (80% baseline vs. 91% follow-up). Only about half the patients perceived AF as a serious condition or were aware that AF predisposes to thromboembolism at baseline. Following the educational intervention there was a non-significant increase in patient knowledge of the risks associated with AF. Of those who completed both questionnaires, 52% were aware that anticoagulants prevented blood clots, which increased to 70% post-intervention. However, few patients were aware of the benefit of stroke prevention associated with anticoagulants at baseline (21%) or after the educational intervention (27%). The intervention had little effect on increasing awareness of the bleeding risks associated with anticoagulants, although three in five people appeared to appreciate these risks. However, the educational intervention significantly improved patient's knowledge of the target INR range and factors that may affect INR levels (p = 0.001 and p = 0.014, respectively) for those who completed both questionnaires.

Conclusions

Most patients with AF possess very limited knowledge about their cardiac condition, its consequences, and how anticoagulant treatment can benefit them. This pilot study has demonstrated that a brief educational intervention with an information booklet can help to somewhat improve their knowledge about anticoagulation therapy for AF.

Introduction

Despite the overwhelming evidence from clinical trials that thromboprophylaxis with warfarin reduces the incidence of stroke and mortality, such therapy remains under-utilised [1], [2], [3]. Patients' beliefs about their healthcare are important factors that influence their decision to accept, decline, or comply with anticoagulant therapy, particularly warfarin [4], [5]. Patients need to understand the importance of attending for regular blood tests, to maintain the INR at an optimal level to prevent bleeding or a stroke, and the interactions of warfarin with antibiotics, alcohol, and foods rich in vitamin K [1], [6]. However, previous studies have demonstrated that many patients with AF possess very little knowledge of their disease [7], [8] and do not understand the risks and/or benefits of anticoagulant therapy [7], [8], [9], [10].

The paucity in patient's knowledge concerning AF could be attributed to the lack of information and explanations given by healthcare professionals due to the time constraints of outpatient clinics, the lack of appropriate educational literature, and the risk/benefit analogies employed by physicians [9]. Evidence suggests that compliance is improved if patients know what they have been prescribed, the reasons for taking it, what will happen if they fail to adhere as prescribed, any factors which may alter drug efficacy, and any possible side effects [11]. Patient education about the consequences of untreated disease and the importance of adhering to the medication regimen is vital to ensure compliance and disease management [11], [12]. Certainly, educational interventions in other chronic diseases, such as diabetes [13], ulcerative colitis [14], heart failure [15], and epilepsy [16] have demonstrated significant improvements in knowledge [13], [14], symptom monitoring [15], disease management [13], [14], [15], and medication compliance [15], [16].

Despite our previous work examining patient's knowledge of the disease and its treatment [7], [8], we are unaware of any study to date which has examined the effect of an educational intervention in AF patients. The aim of this pilot study was to extend our previous work [7], [8] by examining patient's knowledge and perceptions of AF and their anticoagulant treatment, before and after a brief educational intervention, utilising a specifically designed information booklet on AF.