Impact of Vitamin K antagonists on quality of life in a prospective cohort of 807 atrial fibrillation patients

Abstract

Background - Vitamin K antagonists (VKA) use is challenging because of frequent blood monitoring and complex dosing. Therefore, many patients and physicians are reluctant to start VKA. However, it is unclear whether VKA use actually lowers quality of life. We aimed to determine the impact of VKA initiation on quality of life and to analyze the correlation between patient and treatment characteristics and VKA perception in atrial fibrillation patients. Methods and Results - In a prospective cohort of 240 new and 567 long-term VKA users, general quality of life and VKA perception (satisfaction and convenience) were measured at inclusion and at 3 months by the validated Study Short-Form 36 and Perception of Anticoagulant Treatment Questionnaire. Scores were converted to a 0 to 100 scale. Higher scores are more favorable. In the new patients, Medical Outcomes Study Short-Form 36 scores improved during the initial 3 months to a level comparable with the general population. At 3 months, the median convenience score was 95 (Q1-Q3, 88-98) and was higher in older patients (regression coefficient, 0.47 per year; 95% confidence interval, 0.25-0.69) and lower after bleeding (regression coefficient, -12; 95% confidence interval, -20 to -4.7). The median satisfaction score was 64. For the long-term patients, VKA perception scores were highly comparable with the new patients. The convenience score mildly improved in patients with increased individual time in therapeutic range (regression coefficient, 0.03; 95% confidence interval, 0.01-0.05; r 2 =0.01), and satisfaction scores decreased in patients with new comedication (regression coefficient, -7.0; 95% confidence interval, -12 to -1.9; r 2 =0.02). Conclusions - VKA were well tolerated in real-life, and the influences of patient and treatment related factors on VKA perception were very limited.