Educational intervention improves anticoagulation control in atrial fibrillation patients: the TREAT randomised trial

Danielle Clarkesmith, Helen Pattison, Gregory Y.H. Lip, Deirdre A. Lane

Research output: Contribution to journalArticle

Abstract

Background: Stroke prevention in atrial fibrillation (AF), most commonly with warfarin, requires maintenance of a narrow therapeutic target (INR 2.0 to 3.0) and is often poorly controlled in practice. Poor patient-understanding surrounding AF and its’ treatment may contribute to patient’s willingness to adhere to recommendations.
Method: A theory-driven intervention, developed using patient interviews and focus groups, consisting of a one-off group session (1-6 patients) utilising an ‘expert-patient’ focussed DVD, educational booklet, self-monitoring diary and worksheet, was compared in a randomised controlled trial (ISRCTN93952605) against usual care, with patient postal follow-ups at 1, 2, 6, and 12-months. Ninety-seven warfarin-naïve AF patients were randomised to intervention (n=46, mean age (SD) 72.0 (8.2), 67.4% men), or usual care (n=51, mean age (SD) 73.7 (8.1), 62.7% men), stratified by age, sex, and recruitment centre. Primary endpoint was time within therapeutic range (TTR); secondary endpoints included knowledge, quality of life, anxiety/depression, beliefs about medication, and illness perceptions.
Main findings: Intervention patients had significantly higher TTR than usual care at 6-months (76.2% vs. 71.3%; p=0.035); at 12-months these differences were not significant (76.0% vs. 70.0%; p=0.44). Knowledge increased significantly across time (F (3, 47) = 6.4; p<0.01), but there were no differences between groups (F (1, 47) = 3.3; p = 0.07). At 6-months, knowledge scores predicted TTR (r=0.245; p=0.04). Patients’ scores on subscales representing their perception of the general harm and overuse of medication, as well as the perceived necessity of their AF specific medications predicted TTR at 6- and 12-months.
Conclusions: A theory-driven educational intervention significantly improves TTR in AF patients initiating warfarin during the first 6-months. Adverse clinical outcomes may potentially be reduced by improving patients’ understanding of the necessity of warfarin and reducing their perception of treatment harm. Improving education provision for AF patients is essential to ensure efficacious and safe treatment.
Original languageEnglish
Article numbere74037
Number of pages10
JournalPLoS ONE
Volume8
Issue number9
DOIs
Publication statusPublished - 9 Sep 2013

Bibliographical note

© 2013 Clarkesmith et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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  • Research Output

    • 1 Special issue

    Developing a complex educational–behavioural intervention: the TREAT intervention for patients with atrial fibrillation

    Clarkesmith, D., Pattison, H. M., Borg Xuereb, C. & Lane, D. A., 14 Jan 2016, In : Healthcare. 4, 1, 17 p.

    Research output: Contribution to journalSpecial issue

    Open Access
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  • Student Theses

    Development and trialling of a behavioural intervention for patients with atrial fibrillation initiating oral anticoagulation: the 'treat' study

    Author: Clarkesmith, D., 2012

    Supervisor: Pattison, H. (Supervisor), Lane, D. A. (External person) (Supervisor) & Lip, G. Y. (External person) (Supervisor)

    Student thesis: Doctoral ThesisDoctor of Philosophy

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