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Barriers and enablers to adherence to anticoagulation in heart failure with atrial fibrillation: patient and provider perspectives

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  • Caleb Ferguson
  • Sally C. Inglis
  • Phillip J. Newton
  • Sandy Middleton
  • Peter S. Macdonald
  • Patricia M. Davidson

Abstract

Aims & Objectives The purpose of this study was to elucidate the barriers and enablers to adherence to anticoagulation in individuals with chronic heart failure (CHF) with concomitant atrial fibrillation (AF) from the perspective of patients and providers. Background CHF and AF commonly coexist and are associated with increased stroke risk and mortality. Oral anticoagulation significantly reduces stroke risk and improves outcomes. Yet, in approximately 30% of cases, anticoagulation is not commenced for a variety of reasons. Design Qualitative study using narrative inquiry. Methods Data from face‐to‐face individual interviews with patients and information retrieved from healthcare file note review documented the clinician perspective. This study is a synthesis of the two data sources, obtained during patient clinical assessments as part of the Atrial Fibrillation And Stroke Thromboprophylaxis in hEart failuRe (AFASTER) Study. Results Patient choice and preference were important factors in anticoagulation decisions, including treatment burden, unfavourable or intolerable side effects and patient refusal. Financial barriers included cost of travel, medication cost and reimbursement. Psychological factors included psychiatric illness, cognitive impairment and depression. Social barriers included homelessness and the absence of a caregiver or lack of caregiver assistance. Clinician reticence included fear of falls, frailty, age, fear of bleeding and the challenges of multimorbidity. Facilitators to successful prescription and adherence were caregiver support, reminders and routine, self‐testing and the use of technology. Conclusions Many barriers remain to high‐risk individuals being prescribed anticoagulation for stroke prevention. There are a number of enabling factors that facilitate prescription and optimise treatment adherence. Nurses should challenge these treatment barriers and seek enabling factors to optimise therapy. Relevance to clinical practice Nurses can help patients and caregivers to understand complex anticoagulant risk‐benefit information, and act as a patient advocate when making complex stroke prevention decisions.

Suggested Citation

  • Caleb Ferguson & Sally C. Inglis & Phillip J. Newton & Sandy Middleton & Peter S. Macdonald & Patricia M. Davidson, 2017. "Barriers and enablers to adherence to anticoagulation in heart failure with atrial fibrillation: patient and provider perspectives," Journal of Clinical Nursing, John Wiley & Sons, vol. 26(23-24), pages 4325-4334, December.
  • Handle: RePEc:wly:jocnur:v:26:y:2017:i:23-24:p:4325-4334
    DOI: 10.1111/jocn.13759
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    Cited by:

    1. Seyede Fatemeh Gheiasi & Mohammad Ali Cheraghi & Mahdieh Dastjerdi & Hossein Navid & Meysam Khoshavi & Hamid Peyrovi & Alice Khachian & Khatereh Seylani & Maryam Esmaeili & Elham Navab, 2023. "Experiences of Facilitators and Inhibitors to Treatment Adherence in Patients with Heart Failure," Clinical Nursing Research, , vol. 32(3), pages 648-659, March.
    2. Hyun-Joo Seong & Kyounghoon Lee & Bo-Hwan Kim & Youn-Jung Son, 2019. "Cognitive Impairment Is Independently Associated with Non-Adherence to Antithrombotic Therapy in Older Patients with Atrial Fibrillation," IJERPH, MDPI, vol. 16(15), pages 1-11, July.
    3. Ruth V Pritchett & Joanne L Clarke & Kate Jolly & Danielle Clarkesmith & Danai Bem & Grace M Turner & G Neil Thomas & Deirdre A Lane, 2020. "Clinicians’ views and experiences of prescribing oral anticoagulants for stroke prevention in atrial fibrillation: A qualitative meta-synthesis," PLOS ONE, Public Library of Science, vol. 15(5), pages 1-18, May.

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