A study of the impact of substituting Warfarin with Direct Oral Anticoagulants (DOAC), in Atrial Fibrillation (AF) patients over 65 years old: The Patients’ and Clinicians’ Perspectives.

The need for this research was identified during the researcher’s daily practice in her Haematology clinic in London. The clinic specialises in anticoagulated patients, particularly those with the condition of Atrial Fibrillation. The researcher noted that while extensive research had been undertaken into the medical issues associated with the established oral anticoagulant Warfarin, the newer medication referred to as Direct Oral Anticoagulants (DOACs) was less broadly studied. Importantly, little was known about how patients coped on a daily basis with this new treatment. Furthermore, the practical and social impact of a switch from Warfarin to a DOAC for clinical reasons had rarely been studied from the patient’s perspective.

An inductive, mixed-method research study was set up comprising two questionnaires and individual interviews. A sample of 56 patients, aged 65ys and over, grouped by age and sex, were selected from the clinic. The first questionnaire was a Perceived Stress Scale (PSS), which explored the participants’ levels of stress at three time points: the switch over, then at 30 and 90 days. Concurrently a Medical Outcome Study (SF-36), a health survey was administered. Twenty of these patients were also interviewed by the researcher on two occasions, at the switch over then at 90 days. Thematic analysis was undertaken on the transcripts to identify themes across the patients’ responses.

The findings showed that the switch to a DOAC had a positive impact on most of the respondents. They felt liberated from several of the constraints of taking Warfarin, for example, of not needing regular clinical monitoring so being able to travel further and more often, and eating a wider, healthier diet. The patients also reported feeling less stressed in general at the 30 day point, this was sustained over the remainder of the study period. There were some small differences between the ages, the older patients reported fewer benefits from the switch, although remaining positive about the experience. No significant difference was noted between the sexes. Patients highlighted the importance of personal resilience throughout, but that good GP support was also crucial in their continued wellbeing.