Atrial Fibrillation Patients Often Overestimate Stroke and Bleeding Risks

May 24, 2019

Overestimating the bleeding risk of anticoagulants may lead to poor compliance.

Patients with atrial fibrillation (AF) “markedly overestimated” the perceived risks of stroke and bleeding. This poor understanding of the risks can impact whether they take oral anticoagulants, according to a recent study.

In the study, published online March 29 in Mayo Clinic Proceedings, the researchers described the results from a survey of 227 patients with AF. It is the only published survey on patient perceptions of the risks of AF-associated stroke or the risk and benefits of anticoagulation, Mohamad Alkhouli, MD, tells Drug Topics. He is lead author and interventional cardiologist at the West Virginia University Heart and Vascular Institute.

“We felt it is important to assess this because of the implications of taking or not taking long-term anticoagulation in these patients, as well as the impact of good patient understanding on compliance with the medicine,” Alkhouli says.

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Alkhouli and his colleagues surveyed patients with chronic AF who presented for an outpatient cardiology visit or who were admitted to a noncritical care cardiology ward service from September 2017, through December 2017. Participants were asked to estimate their stroke risk without oral anticoagulation (OAC) and bleeding risk with OAC using a quantitative risk scale.

Most patients (40.5%) had a history of bleeding, and most of them overestimated their risks of stroke and bleeding, the researchers found. Nearly 53% perceived an annual stroke risk greater than 20%, and 53.5% perceived an annual bleeding risk with OAC greater than 10%.

Most patients perceived that OAC would reduce their annual stroke risk by at least 50%. Around 76% of patients were taking OACs. Among the 54 patients who were not taking OACs, fear of bleeding was the predominant reason.

Patients who were taking OACs did so to reduce their risk of stroke (75.7%), due to physician recommendations (12%), and for uncertain reasons (8.7%). Approximately half of the patients were not aware or did not know of any other prevention option besides blood thinners.

“Perceived risks of stroke and bleeding are markedly overestimated in most patients with AF. Further research is needed to discern the root causes and to identify effective methods of bridging this alarming disparity,” Alkhouli says.

However, Alkhouli was not surprised by the results because “the medical community has embraced the relative risk terminology, which is a language that is not plausible for most patients,” he says.

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“We suspected a large discrepancy between predicted and perceived risk. For example, when patients ask about the benefit of anticoagulation, they are often told that it would reduce the annual stroke risk by 50%, which is true, but this can mean reducing the actual annual risk from 2.2% to 1.1%, which is a much more plausible number to understand. Patients live in the absolute world and information needs to be related to them in a simple, relevant method,” Alkhouli says.

Emphasizing the need to understand the risk and benefit of the treatment can help AF patients become more compliant and make informed decisions about their health, Alkhouli adds.