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Atrial fibrillation. --- Transient ischemic attack.

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Background : Direct oral anticoagulants (DOACs) (rivaroxaban, apixaban and dabigatran etexilate) and vitamin K antagonists (VKAs) are used for stroke prevention in atrial fibrillation (AF). Given the short half-life and lack of laboratory monitoring of DOACs, optimal adherence is essential. Collecting blood samples at regular intervals for patients under VKASs should lead to a better adherence and to less adverse consequences for the patients. There is a lack of data on anticoagulation adherence in clinical practice. This is particularly true for DOACs. Objectives: To assess anticoagulation adherence in a non-academic hospital and the potential causes behind non adherence to treatment by VKAs or DOACs, on the one hand, and to identify the most suitable tools to assess this adherence, on the other hand. Patients/Methods: Cross-sectional study of patients under VKAs or DOACs used for stroke prevention in AF. A literature review for adherences tools was conducted to identify the most relevant technique to evaluate adherence of patients who are taking anticoagulant for AF. Anticoagulation adherence was evaluated using two subjective methods (the 8-items Morisky Medication Adherence Scale (MMAS-8) and the Adherence to Refill and Medications Scale (ARMS)) and two objective methods (the Medication possession ration (MPR) and the Time in Therapeutic Range (TTR)). MMAS-8 and ARMS were used for patients taking VKAs and DOACs, MPR was selected for patients taking DOACs and TTR was chosen for patients under VKAs. Results: Thirty patients answered to the survey; 30% of them were under VKAs and 70% of them under DOACs. For all the patients, anticoagulation adherence using MMAS-8 was 96.7% and reached 93.3% using ARMS. 88.2% of patients on DOACs had a MPR>= 80%. Only one patients had TTR >= 75%. The potential predictors of VKAs non-adherence were side effects (bleeding) and the complexity of the treatment (dose adjustment related to INR control). For all the patients, refilling prescriptions was a potential cause of non-adherence. Conclusion: Anticoagulation adherence was important according to MMAS-8, ARMS and MPR but not according to TTR. MMAS-8, ARMS, MPR and TTR provide simple assessment of anticoagulation adherence; however conduction large scale studies using these tools in the case of patients with atrial fibrillation would be useful to support our results.

Atrial Fibrillation --- Anticoagulants --- Ambulatory Care --- Patient Compliance

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This book provides a road map for the efficient and successful management of atrial fibrillation (AF) in the short stay unit. It describes the problem, defines the measures of successful treatment, elucidates interventions, and supplies the tools for achieving quality care. Organized in four parts, it covers the impact of AF on patient populations; the presentation and management of AF; the transition to the outpatient environment; and systems management. Topics include the economic consequences of AF; cardioversion and cardiac implantable electronic devices in AF management; education of the AF patient and discharge planning; and quality metrics in AF. The book also provides order sheets and process criteria with which institutions can successfully manage the AF patient in the short stay unit, thus optimizing patient outcomes, patient satisfaction, and operational efficiencies. Short Stay Management of Atrial Fibrillation is a valuable resource for cardiologists, emergency medicine physicians, electrophysiologists, and other healthcare professionals involved in AF management.

Medicine. --- Emergency medicine. --- Cardiology. --- Medicine & Public Health. --- Emergency Medicine. --- Atrial fibrillation --- Treatment. --- Auricular fibrillation --- Atrial arrhythmias --- Medicine, Emergency --- Medicine --- Critical care medicine --- Disaster medicine --- Medical emergencies --- Heart --- Internal medicine --- Diseases