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

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)4325-4334
Number of pages10
JournalJournal of Clinical Nursing
Volume26
Issue number23-24
DOIs
StatePublished - Dec 1 2017

Fingerprint

Atrial Fibrillation
Heart Failure
Stroke
Caregivers
Causality
Fear
Prescriptions
Nurses
Homeless Persons
Costs and Cost Analysis
Patient Preference
Information Storage and Retrieval
Therapeutics
Anticoagulants
Psychiatry
Comorbidity
Interviews
Depression
Hemorrhage
Psychology

Keywords

  • anticoagulation
  • atrial fibrillation
  • caregiver
  • heart failure
  • medication adherence
  • stroke prevention
  • thromboprophylaxis

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Barriers and enablers to adherence to anticoagulation in heart failure with atrial fibrillation : patient and provider perspectives. / Ferguson, Caleb; Inglis, Sally C.; Newton, Phillip J.; Middleton, Sandy; Macdonald, Peter S.; Davidson, Patricia M.

In: Journal of Clinical Nursing, Vol. 26, No. 23-24, 01.12.2017, p. 4325-4334.

Research output: Contribution to journalArticle

Ferguson, Caleb ; Inglis, Sally C. ; Newton, Phillip J. ; Middleton, Sandy ; Macdonald, Peter S. ; Davidson, Patricia M. / Barriers and enablers to adherence to anticoagulation in heart failure with atrial fibrillation : patient and provider perspectives. In: Journal of Clinical Nursing. 2017 ; Vol. 26, No. 23-24. pp. 4325-4334.
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