Determinants of anticoagulation knowledge among patients with atrial fibrillation receiving long-term oral anticoagulant therapy
H G Uzun, F Pirmammadova, A Mammadli, A C Urganci, Y Borna, A Rzayeva, M Zoghi, M Kayikcioglu, E SimsekAbstract
Background
Atrial fibrillation is the most common sustained arrhythmia and requires long-term oral anticoagulant therapy to prevent stroke, yet many patients have limited understanding of their condition and treatment safety. We aimed to quantify knowledge gaps and identify predictors of anticoagulation awareness in routine practice.
Purpose
To assess awareness of arrhythmia diagnosis and oral anticoagulant therapy among patients with atrial fibrillation and to identify demographic predictors of a composite anticoagulation knowledge score.
Methods
In a cross-sectional survey, consecutive outpatients with non-valvular atrial fibrillation receiving vitamin K antagonists or direct oral anticoagulants completed a face-to-face questionnaire covering five domains: demographics, medical history, medication profile, knowledge/adherence, and use/perception. A six-item knowledge score (range 0–6) awarded 1 point each for knowing the arrhythmia name, treatment indication, dosing schedule, potential side effects, drug interactions, and at least one possible clinical consequence of dose change. Multivariable linear regression examined associations between age, sex, education and knowledge.
Results
We studied 261 patients (median age 67 years, 50% women, Table 1). Only 16.5% could name atrial fibrillation as their rhythm disorder and 75.1% correctly identified stroke prevention as the indication for anticoagulation. Awareness of bleeding side effects was present in 32% and only 12% knew any relevant drug interactions. More than one-third of patients (42.5%) stated they had not received any counseling or written information about oral anticoagulant therapy at initiation, or did not recall receiving such information; nearly half (48%) felt that the information provided by healthcare professionals was insufficient. Many patients reported a need for additional information (n=60%, n=158, Table 2). Overall, 45% scored ≤2 points; mean knowledge score was 2.8 ± 1.3. Self-reported adherence was high (94% "always" adherent). In adjusted analyses, higher education was independently associated with greater knowledge (β +0.3 points per education level, p < 0.001), whereas older age (β −0.02 per year, p = 0.01) and male sex (β −0.6 vs female, p < 0.001) predicted lower scores (model R² = 0.18).
Conclusion
In this real-world anticoagulated atrial fibrillation cohort, patient knowledge about arrhythmia diagnosis, indication, safety and interactions of oral anticoagulants was modest despite excellent self-reported adherence. Older, less educated and male patients were least informed, highlighting priority targets for structured education to support safer, more informed oral anticoagulant use.Table 1Table 2