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

  • Danielle Clarkesmith

Student thesis: Doctoral ThesisDoctor of Philosophy


Purpose: Atrial fibrillation (AF) is the most common heart arrhythmia and is
associated with an increased risk of stroke. Stroke risk is commonly treated with oral anticoagulation (OAC) with a narrow therapeutic range (INR 2.0 to 3.0); which is poorly controlled in practice. Barriers to adherence include poor knowledge, and inaccurate perceptions surrounding illness and medications. Trial registration:
ISRCTN93952605. Systematic review: Seven trials of educational, self-monitoring and decision aid
interventions were included in a systematic review. Pooled analysis suggested education OR, 95% CI 7.89 (5.54-10.24) and self monitoring OR (95% CI) 5.47(2.55-8.39) significantly improve TTR; whereas decision aids are no more effective in reducing decision conflict than usual care, OR (95% CI) -0.10 (-0.17 to -0.02).
Intervention development: The intervention was theoretically-driven (utilising the common sense and beliefs about medication models) and developed with expert patient feedback. Described using behavioural change techniques, the one-off group
session included an educational booklet, ‘expert-patient’ focussed DVD, and worksheet. Methods: Ninety seven warfarin-naïve AF patients were randomised to receive the intervention (n=43), or usual care (n=54). The primary endpoint was time within
therapeutic range (TTR), secondary endpoints included knowledge, quality of life (AF-QoL-18), beliefs about medication (BMQ), illness perceptions (IPQ-B), and anxiety and depression (HADS). Results: Intervention group had significantly higher TTR than usual care (78.5% vs. 66.7%; p=0.01). Knowledge changed significantly across time (F (3, 47) = 6.4; p<0.01), but not between groups (F (1, 47) = 3.3; p = 0.07). At six months knowledge predicted TTR (r=0.245; p=0.04). Illness concern negatively correlated with TTR (r= -
0.199; p=0.05). General Harm scores at one month predicted TTR (F (1, 72) = 4.08; p=0.048). There were significant differences in emotional representations (F (3, 49) =
3.3 (3, 49); p= 0.03), anxiety (F (3, 46) = 25.2; p<0.01) and depression (F (3, 46) = 37.7; p<0.01) across time.
Conclusion: A theory-driven educational intervention can improve TTR in AF
patients and potentially reduce the risk of adverse clinical outcomes. Improving
education provision for AF patients is essential to ensure efficacious treatment.
Date of Award2012
Original languageEnglish
SupervisorHelen Pattison (Supervisor), Deirdre A. Lane (Supervisor) & Gregory Y.H. Lip (Supervisor)


  • atrial fibrillation
  • health intervention
  • illness perceptions
  • beliefs about medication
  • oral anticoagulation

Cite this