More than two-thirds of atrial fibrillation (AFib) patients who take oral anticoagulant (OAC) medication underestimate their risk of a major bleeding episode, according to new data published in the Journal of the American Heart Association.
“Patients with misperceptions of their bleeding risk may be unable to engage in informed treatment decision making and may be more at risk for nonadherence to monitoring activities and lifestyle modifications necessary for successful anticoagulation,” wrote first author Benita A. Bamgbade, PharmD, PhD, a specialist at Northeastern University, and colleagues.
The study’s authors found that little research had been done to evaluate how the bleeding risk perceptions of AFib patients compared with their actual risks. To learn more about that topic, they tracked data from 754 adult AFib patients treated at one of five ambulatory care sites in Massachusetts and Georgia between 2015 and 2018. All patients were 65 years or older and on OAC medication.
Data came from the SAGE‐AF (Systematic Assessment of Geriatric Elements in Atrial Fibrillation) study, which involved structured in-person interviews with each participant. While 52% of participants were men, 86% were non-Hispanic white. The mean patient age was 74.8 years old.
Sixty-nine percent of patients who participated in the study reported bleeding risk perceptions that were different from their predicted bleeding risk. Among these patients, almost 2% overestimated their bleeding risk and all other patients underestimated their risk.
The authors also found that a significantly higher proportion of patients who correctly estimated their bleeding risk were women, whereas participants with medical comorbidities such as heart failure (HF), peripheral vascular disease, hypertension, stroke, anemia, and renal disease were more inclined to underestimate their bleeding risk.
In the unadjusted model, women were less likely to underestimate their bleeding risk.
Also, in the unadjusted model, patients with the comorbidities such as HF, peripheral vascular disease, hypertension, stroke, anemia and renal disease had significantly higher odds of underestimating their bleeding risk.
Asian or Pacific Islander, Black, Native American or Alaskan Native, Mixed Race or Hispanic (non‐White) patients were 55% less likely to underestimate their bleeding risk than white patients. Women, meanwhile, were 38% less likely to underestimate their bleeding risk than men. Patients with a history of bleeding, hypertension, stroke or renal disease had significantly higher odds of underestimating the bleeding risk.
“As knowledge was not associated with underestimating bleeding risk perceptions, clinicians should consider educational strategies that focus on strengthening provider–patient relationships that may help align patient bleeding risk perceptions with predicted bleeding risk," the authors wrote.
Bamgbade et al. noted that more research is warranted in order to better understand how patient pharmaceutical risk perceptions affect patient health behaviors and subsequent outcomes.
Read the entire study here.