COMPARISON OF HEALTH RELATED QUALITY OF LIFE AMONG PATIENTS USING NOVEL ORAL ANTICOAGULANTS OR WARFARIN FOR NONVALVULAR ATRIAL FIBRILLATION
K. Balci, U. Canpolat, F. Sen, M.K. Akboga, M. Suleymanoglu, S. Kuyumcu, O. Maden, H. Selcuk, T. Selcuk
Cardiology, Turkiye Yuksek Ihtisas Research and Education Hospital, Ankara, Turkey
Introduction: The usage of warfarin is complicated due to highly variable biological effects and its narrow therapeutic index. Therefore, we compared health related quality of life (HRQoL) measures and hospital anxiety and depression scale (HADS) scores between new oral anticoagulants (NOACs) and warfarin treated patients for non-valvular atrial fibrillation (AF).
Methods: A total of 182 patients with non-valvular AF were included in this cross-sectional study. A questionnaire was performed in all participants to evaluate HRQoL, depression and anxiety. In the NOAC group, all patients were treated with warfarin previously.
Results: The annual number of hospital admissions was significantly higher in the warfarin group (p< 0.001) and all of the HRQoL scores were significantly lower, both of HADS scores were higher in the warfarin group (p< 0.001).History of any type bleeding was significantly higher in the warfarin group (p< 0.001).Among patients who experienced bleeding, all of the HRQoL scores were significantly lower and HADS-Depression score was significantly higher (p< 0.001; p=0.002, respectively).
Conclusions: Warfarin treated patients had higher levels of self-reported symptoms of depression and anxiety and compromised HRQoL when compared to NOAC-treated patients.
Baseline characteristics of the study groups (n=182).
|
Variables
|
Warfarin group
(n=91)
|
NOAC group
(n=91)
|
p-value
|
|
Age, years, mean±SD
|
64.8±10.2
|
66.2±10.1
|
0.347†
|
|
Female gender
|
48 (52.7%)
|
43 (47.3%)
|
0.459‡
|
|
Education level
|
|
|
|
|
Uneducated
|
17 (18.7%)
|
24 (26.4%)
|
0.273‡
|
|
Primary school
|
66 (72.5%)
|
63 (69.2%)
|
|
Middle & High school
|
8 (8.8%)
|
4 (4.4%)
|
|
Marital status
|
|
|
|
|
Married
|
80 (87.9%)
|
68 (74.7%)
|
0.022
‡
|
|
Unmarried
|
11 (12.1%)
|
23 (25.3%)
|
|
Duration of OACs therapy (months)
|
20 (9-38)
|
9 (7-12.5)
|
<0.001
¶
|
|
Medication
|
|
|
-
|
|
Warfarin
|
91 (100%)
|
-
|
|
|
Dabigatran 150mg bid
|
-
|
37 (40.7%)
|
|
|
Dabigatran 110mg bid
|
-
|
10 (11.0%)
|
|
|
Rivaroxaban 20mg od
|
-
|
16 (17.6%)
|
|
|
Apixaban 5mg bid
|
-
|
26 (28.6%)
|
|
|
Apixaban 2.5mg bid
|
-
|
2 (2.2%)
|
|
|
LVEF, %
|
55 (15-65)
|
60 (15-60)
|
0.267¶
|
|
Hypertension, n (%)
|
67 (73.6%)
|
66 (72.5%)
|
0.867‡
|
|
Coronary artery disease, n (%)
|
54 (59.3%)
|
38 (41.8%)
|
0.018
‡
|
|
Diabetes mellitus, n (%)
|
17 (18.7%)
|
18 (19.8%)
|
0.851‡
|
|
Heart failure, n (%)
|
27 (29.7%)
|
25 (27.5%)
|
0.743‡
|
|
CHA2DS2 –VASc, median
|
3 (1-8)
|
3 (1-7)
|
0.421¶
|
|
Medical compliance (MMAS-4 <2, n (%)
|
70 (76.9%)
|
78 (85.7%)
|
0.128‡
|
|
Annual number of hospital admissions, mean±S.D.
|
12.8±3.5
|
5.0±1.3
|
<0.001
†
|
|
EHRA score, median (min-max)
|
|
|
|
|
1
|
34 (37.4%)
|
54 (59.3%)
|
0.010
¶
|
|
2
|
44 (48.4%)
|
26 (28.6%)
|
|
3
|
13 (14.3%)
|
10 (11.0%)
|
|
4
|
0 (0.0%)
|
1 (1.1%)
|
|
HAS-BLED score
|
|
|
|
|
0-2
|
72(79.1%)
|
68(74.7%)
|
0.824¶
|
|
?3
|
19 (20.9%)
|
23 (25.3%)
|
Comparison of quality of life, anxiety and depression levels of patients according to occurrence of any type bleeding event (n=182).
|
Variables
|
Bleeding (-)
(n=137)
|
Bleeding (+)
(n=45)
|
p-value
†
|
|
Physical functioning
|
71.3±21.2
|
53.1±20.5
|
<0.001
|
|
Role physical
|
70.8±28,0
|
38.3±31.3
|
<0.001
|
|
Bodily pain
|
75.5±23.3
|
52.2±27.6
|
<0.001
|
|
General health
|
55.9±20.6
|
34.2±22.8
|
<0.001
|
|
Vitality
|
55.4±19.8
|
39.6±19.9
|
<0.001
|
|
Social functioning
|
76.2±21.3
|
49.2±23.4
|
<0.001
|
|
Role emotional
|
69.3±25.6
|
45.9±23.9
|
<0.001
|
|
Mental functioning
|
68.6±14.5
|
59.6±14.1
|
<0.001
|
|
HADS-A
|
5.3±1.4
|
5.5±1.5
|
0.352
|
|
HADS-D
|
4.2±1.3
|
4.8±1.3
|
0.002
|
†Student's t test, HADS: Hospital Anxiety and Depression Scale; HADS-A: Anxiety subscale of HADS; HADS-D: Depression subscale of HADS.
