A systematic review of patient‐reported outcomes associated with the use of direct‐acting oral anticoagulants

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Abstract

Aims
Patient‐reported outcomes (PROs) are a distinctive method of evaluating patient response to health care or treatment. This systematic review aimed to analyse the impact of PROs in patients on direct oral anticoagulant (DOAC) treatment, prescribed for any indication (e.g. venous thromboembolism treatment or atrial fibrillation) using controlled trials (CT) and real‐world observational studies (OS).

Methods
A systematic search of articles was conducted according to PRISMA guidelines using databases, with the last update in November 2018. The Cochrane Collaboration tool for assessing bias in randomized CTs and the Newcastle‐Ottawa Scale adapted for cross‐sectional studies were used. Outcomes evaluated were related to health‐related quality of life (HRQoL), satisfaction, adherence and compliance.

Results
Twenty‐one original studies (6 CT, 15 OS) were included. HRQoL was assessed by 6 (1 CT, 5 OS) studies and reported that HRQoL scores were similar in patients on DOACs and warfarin. Patients prescribed DOACs presented higher HRQoL scores which were attributed to lack of intense monitoring required compared with warfarin but this was not statistically significant. The majority of studies (5 CT, 9 OS) investigated patient‐reported satisfaction, indicating greater satisfaction with DOACs with significantly lower burden and increased benefit scores for patients on DOACs. Patient‐reported expectations, compliance and adherence were similar for patients on DOACs and warfarin.

Conclusion
Patients appear to prefer treatment with DOACs vs warfarin. This is shown by the higher quality of life, satisfaction and adherence described in the studies. However, heterogeneity in the analysed studies does not allow firm conclusions.
Original languageEnglish
JournalBritish Journal of Clinical Pharmacology
Early online date26 Jun 2019
DOIs
Publication statusE-pub ahead of print - 26 Jun 2019

Fingerprint

Anticoagulants
Warfarin
Quality of Life
Observational Studies
Compliance
Venous Thromboembolism
Therapeutics
Atrial Fibrillation
Databases
Guidelines
Delivery of Health Care

Cite this

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title = "A systematic review of patient‐reported outcomes associated with the use of direct‐acting oral anticoagulants",
abstract = "AimsPatient‐reported outcomes (PROs) are a distinctive method of evaluating patient response to health care or treatment. This systematic review aimed to analyse the impact of PROs in patients on direct oral anticoagulant (DOAC) treatment, prescribed for any indication (e.g. venous thromboembolism treatment or atrial fibrillation) using controlled trials (CT) and real‐world observational studies (OS).MethodsA systematic search of articles was conducted according to PRISMA guidelines using databases, with the last update in November 2018. The Cochrane Collaboration tool for assessing bias in randomized CTs and the Newcastle‐Ottawa Scale adapted for cross‐sectional studies were used. Outcomes evaluated were related to health‐related quality of life (HRQoL), satisfaction, adherence and compliance.ResultsTwenty‐one original studies (6 CT, 15 OS) were included. HRQoL was assessed by 6 (1 CT, 5 OS) studies and reported that HRQoL scores were similar in patients on DOACs and warfarin. Patients prescribed DOACs presented higher HRQoL scores which were attributed to lack of intense monitoring required compared with warfarin but this was not statistically significant. The majority of studies (5 CT, 9 OS) investigated patient‐reported satisfaction, indicating greater satisfaction with DOACs with significantly lower burden and increased benefit scores for patients on DOACs. Patient‐reported expectations, compliance and adherence were similar for patients on DOACs and warfarin.ConclusionPatients appear to prefer treatment with DOACs vs warfarin. This is shown by the higher quality of life, satisfaction and adherence described in the studies. However, heterogeneity in the analysed studies does not allow firm conclusions.",
keywords = "s Direct-acting oral anticoagulants, patient reported outcomes, systematic review, warfarin, patient-reported outcomes, direct-acting oral anticoagulants",
author = "Saima Afzal and Hasan, {Syed Shahzad} and Zaheer-Ud-Din Babar",
year = "2019",
month = "6",
day = "26",
doi = "10.1111/bcp.13985",
language = "English",
journal = "British Journal of Clinical Pharmacology",
issn = "0306-5251",
publisher = "Wiley-Blackwell",

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T1 - A systematic review of patient‐reported outcomes associated with the use of direct‐acting oral anticoagulants

AU - Afzal, Saima

AU - Hasan, Syed Shahzad

AU - Babar, Zaheer-Ud-Din

PY - 2019/6/26

Y1 - 2019/6/26

N2 - AimsPatient‐reported outcomes (PROs) are a distinctive method of evaluating patient response to health care or treatment. This systematic review aimed to analyse the impact of PROs in patients on direct oral anticoagulant (DOAC) treatment, prescribed for any indication (e.g. venous thromboembolism treatment or atrial fibrillation) using controlled trials (CT) and real‐world observational studies (OS).MethodsA systematic search of articles was conducted according to PRISMA guidelines using databases, with the last update in November 2018. The Cochrane Collaboration tool for assessing bias in randomized CTs and the Newcastle‐Ottawa Scale adapted for cross‐sectional studies were used. Outcomes evaluated were related to health‐related quality of life (HRQoL), satisfaction, adherence and compliance.ResultsTwenty‐one original studies (6 CT, 15 OS) were included. HRQoL was assessed by 6 (1 CT, 5 OS) studies and reported that HRQoL scores were similar in patients on DOACs and warfarin. Patients prescribed DOACs presented higher HRQoL scores which were attributed to lack of intense monitoring required compared with warfarin but this was not statistically significant. The majority of studies (5 CT, 9 OS) investigated patient‐reported satisfaction, indicating greater satisfaction with DOACs with significantly lower burden and increased benefit scores for patients on DOACs. Patient‐reported expectations, compliance and adherence were similar for patients on DOACs and warfarin.ConclusionPatients appear to prefer treatment with DOACs vs warfarin. This is shown by the higher quality of life, satisfaction and adherence described in the studies. However, heterogeneity in the analysed studies does not allow firm conclusions.

AB - AimsPatient‐reported outcomes (PROs) are a distinctive method of evaluating patient response to health care or treatment. This systematic review aimed to analyse the impact of PROs in patients on direct oral anticoagulant (DOAC) treatment, prescribed for any indication (e.g. venous thromboembolism treatment or atrial fibrillation) using controlled trials (CT) and real‐world observational studies (OS).MethodsA systematic search of articles was conducted according to PRISMA guidelines using databases, with the last update in November 2018. The Cochrane Collaboration tool for assessing bias in randomized CTs and the Newcastle‐Ottawa Scale adapted for cross‐sectional studies were used. Outcomes evaluated were related to health‐related quality of life (HRQoL), satisfaction, adherence and compliance.ResultsTwenty‐one original studies (6 CT, 15 OS) were included. HRQoL was assessed by 6 (1 CT, 5 OS) studies and reported that HRQoL scores were similar in patients on DOACs and warfarin. Patients prescribed DOACs presented higher HRQoL scores which were attributed to lack of intense monitoring required compared with warfarin but this was not statistically significant. The majority of studies (5 CT, 9 OS) investigated patient‐reported satisfaction, indicating greater satisfaction with DOACs with significantly lower burden and increased benefit scores for patients on DOACs. Patient‐reported expectations, compliance and adherence were similar for patients on DOACs and warfarin.ConclusionPatients appear to prefer treatment with DOACs vs warfarin. This is shown by the higher quality of life, satisfaction and adherence described in the studies. However, heterogeneity in the analysed studies does not allow firm conclusions.

KW - s Direct-acting oral anticoagulants

KW - patient reported outcomes

KW - systematic review

KW - warfarin

KW - patient-reported outcomes

KW - direct-acting oral anticoagulants

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U2 - 10.1111/bcp.13985

DO - 10.1111/bcp.13985

M3 - Review article

JO - British Journal of Clinical Pharmacology

JF - British Journal of Clinical Pharmacology

SN - 0306-5251

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