Telephone interviews were conducted in 2012 in England by ACE (AnticoagulationEurope) and AFA (Atrial Fibrillation Association) with 104 patients with atrial fibrillation. The results, even with this small sample, represent the problems associated with the treatment of patients with atrial fibrillation. For 72 % of patients the treatment with Vitamin-K-Antagonists started immediately; for 20 % however, it started only after a longer period of time (up to one year). 75 % of the interviewed patients were verbally informed about the treatment, whereas only 36 % were able to explain that anticoagulation can prevent strokes. Only 25 % sought further information. "Doctors should take stronger influence on the insufficient INR-controls and make patients to equal partners in the handling of their treatment with anticoagulants", says Eve Knight (ACE).
Patients need information they can understand. Information provided verbally – often very quickly – are not always fully understood. Especially given the complexity of anticoagulation more than verbal information is needed. Many globally available medical publications address the question how the patient can be involved to cooperate. Proposals are plentiful. Prof. Dr. med G. Lip et al: "Patients need clear and simple information, tailor made to their personality" (Thromb. Haemost 2011, 106:997-1011).
However, anticipating that – as shown in the survey – only 25 % of patients seek further information, meaning they are interested and want to cooperate, it is not surprising that the essential treatment with anticoagulants is a “red rag” for both doctors and patients.
INR Self-Management could be the key to effective patient cooperation. M. Schwebe et al, University of Greifswald, Germany, write: “Incomprehension exists even within experts that only 20 % of all patients in Germany on VKA anticoagulation therapy practice Patient-Self-Management (PSM)” (PharmacoEconomics – German Research Articles 2012: 10 [1]).
Doesn’t motivation for the weekly INR-Test start with the questions: Am I within the therapeutic range? If not, what did I do incorrect and what can I change and potentially improve with my lifestyle?
Prof. Dr. med. Hugo ten Cate nails it: "Quality of life and time within therapeutic range can be influenced positively through INR Self-Management" (Thrombosis and Haemostasis 107.5/2012).
Christian Schaefer, ISMAAP
