Quality of life and patient satisfaction in patients with atrial fibrillation on stable vitamin K antagonist treatment or switched to a non-vitamin K antagonist oral anticoagulant during a 1-year follow-up: A PREFER in AF Registry substudy

Arch Cardiovasc Dis. 2018 Feb;111(2):74-84. doi: 10.1016/j.acvd.2017.04.007. Epub 2017 Sep 21.


Background: Non-vitamin K antagonist oral anticoagulants (NOACs) are being introduced for stroke prevention in non-valvular Atrial Fibrillation (AF), and promise to be accepted better than Vitamin K Antagonists (VKAs) by patients, improving their Quality of Life (QoL).

Aim: To assess to what extent patient-related factors influence decisions to switch from a VKA to a NOAC.

Methods: The PREFER in AF Registry collected data at baseline in 2012 - at the beginning of NOAC prescriptions - and at 1-year follow-up, in 6412 patients in seven Western European countries. QoL and patient satisfaction questionnaires (EQ-5D-5L and/or PACT-Q2) were completed in 3777 patients at both visits. Data were compared across categories of patients on stable treatment with a VKA (i.e. continuously over the previous 12 months) (n=2102) or recently switched (within 12 months) from a VKA to a NOAC (n=213) during a 1-year follow-up, allowing a snapshot of factors influencing the switch at a time when NOACs were being introduced into the market.

Results: Compared to patients on stable treatment with a VKA, switched patients were similar in terms of age, sex, body mass index and other risk factors, but had lower prevalences of hypertension and heart valve dysfunction, and a lower rate of use of concomitant treatment with antiplatelet/anti-inflammatory agents; they also had a lower CHA2DS2-VASc score. Among 25 features investigated, switched patients more often reported bruising or bleeding, complained about bruising, were dissatisfied with the anticoagulant treatment, and reported mobility problems and anxiety/depressive traits.

Conclusions: At the beginning of NOAC prescriptions, European doctors tended to switch from VKAs to NOACs those patients at lower risk than "non-switchers". Complaints about bruising or bleeding, dissatisfaction with treatment, mobility problems and anxiety/depression traits appear to be related to - and may have influenced - the choice to switch from a VKA to a NOAC.

Keywords: Anticoagulants oraux directs; Antivitamine K; Atrial fibrillation; Changement de traitement; Fibrillation atriale; Non-vitamin K antagonist oral anticoagulants; Patient satisfaction; Quality of life; Qualité de vie; Satisfaction du patient; Switching; Vitamin K antagonists.

Publication types

  • Multicenter Study

MeSH terms

  • Activities of Daily Living
  • Administration, Oral
  • Aged
  • Aged, 80 and over
  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects
  • Atrial Fibrillation / blood
  • Atrial Fibrillation / complications
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / drug therapy*
  • Blood Coagulation / drug effects*
  • Drug Substitution*
  • Europe
  • Female
  • Follow-Up Studies
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Patient Satisfaction*
  • Quality of Life*
  • Registries
  • Risk Factors
  • Stroke / blood
  • Stroke / diagnosis
  • Stroke / etiology
  • Stroke / prevention & control*
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome
  • Vitamin K / antagonists & inhibitors*


  • Anticoagulants
  • Vitamin K