Anticoagulation control in patients with atrial fibrillation

Zulkifly, Hanis Hanum Binti (2019). Anticoagulation control in patients with atrial fibrillation. University of Birmingham. Ph.D.

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Abstract

To examine self-reported depression, anxiety, beliefs about medication, knowledge of AF, and quality of life in newly anticoagulated atrial fibrillation (AF) patients and to investigate anticoagulation control, measured by time in therapeutic range (TTR) in AF patients and operated valvular heart disease (VHD) patients, prescribed long-term VKA therapy.

Study I: AF patients have low levels of depression and anxiety, and positive beliefs about medication. AF knowledge and quality of life was poor. Results were unchanged at 6 months but AF symptoms and awareness of AF consequences improved.

Study 2: TTR was significantly lower in South-Asians (60.5%) and Afro-Caribbeans (61.3%) compared to Whites (67.9%; p<0.00 1] despite similar INR monitoring intensity. TTR was similar among elderly (≥80 vs. <80 years) patients and those with/without chronic kidney disease. Non-white ethnicity was the strongest independent predictor of poor TTR.

Study 3: TTR was significantly poorer in operated VHD patients with AF (55.7%) compared to those without AF (60.1 %; p=0.002). Independent predictors of poor TTR: female sex. AF and anaemia/bleeding history.

Conclusion: Newly anticoagulated AF patients had poor quality of life and limited AF knowledge. 1TR was sub-optimal (TTR<70%) among non-white AF patients and operated VHD patients with AF.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):