Investigation On The Willingness To Choose Oral Anticoagulants In Patients With Atrial Fibrillation

Objective: To explore the differences in the choice of traditional oral anticoagulants(warfarin)and existing new oral anticoagulants(dabigatran,rivaroxaban,etc)in patients with atrial fibrillation(AF),and to understand the main considerations of patients in the choice of these drugs;to improve the current situation of insufficient anticoagulant therapy.Methods:A discrete selection experiment was used to design a questionnaire.A total of 150 patients with non-valvular atrial fibrillation diagnosed in the Department of Cardiology of the Second Hospital of Hebei Medical University from July 2019 to January 2020 were selected to conduct a questionnaire survey.139 valid questionnaires were collected to collect relevant data.Descriptive statistical analysis was performed on the basic situation of patients with AF using Stata software,and the mixed Logit model in discrete selection experiment was used to analyze the six attribute preferences of oral anticoagulants in patients with atrial fibrillation,including drug frequency,regular monitoring of blood indexes,specific antagonists,interaction with food / drug,need of bridging and cost,and the willingness to pay for some of the above attributes.Results:1.Of the 139 patients,79 were male(56.8%),60 female(43.2%),the average age was 63.63 ±10.74 years(33-83 years old),87 cases with paroxysmal atrial fibrillation(62.60%),52 cases with persistent atrial fibrillation(37.40%),15 cases without complications(10.79%),55 cases with less than 2 diseases(39.57%),69 cases with 3 or more diseases(49.64%).The regression coefficients of medication frequency,regular monitoring of blood indexes,interaction with food / drug,need for low molecular weight heparin bridging and cost were all negative,which had a negative effect on the choice of oral anticoagulants in patients with atrial fibrillation.The properties of specific antagonists were not statistically significant.2.In the willingness to pay,patients are willing to pay 72.77 yuan per day to achieve no food / drug interaction,67.6 yuan per day to achieve blood indicators without regular monitoring,39.76 yuan per day to bridge without low molecular weight heparin,and 27.83 yuan to take drugs only once a day.3.There are age,gender and regional differences in the preference for oral anticoagulants in patients with atrial fibrillation.Patients over 65 years old pay more attention to various attributes than patients under 65 years old,men pay more attention to food / drug interaction and regular monitoring of blood indexes,while women pay more attention to the need for low molecular weight heparin bridging and medication frequency than men.Patients living in villages,towns and counties attach importance to regular monitoring of blood indexes and need low molecular weight heparin bridging,while urban residents attach importance to food / drug interaction,regular monitoring of blood indexes and frequency of medication;paroxysmal.Patients with atrial fibrillation do not need to monitor blood indexes regularly,while patients with persistent atrial fibrillation pay more attention to food / drug interaction.Patients with paroxysmal atrial fibrillation are more willing to pay for each attribute than patients with persistent atrial fibrillation.Patients with two kinds of chronic diseases pay attention to no food / drug interaction,patients with three or more chronic diseases do not need to monitor blood indexes regularly,and pay more attention to each attribute than patients with a small number of diseases,and patients who have undergone atrial fibrillation ablation are more willing to pay for each attribute than those who have not received surgical treatment.Conclusion:The attributes of patients' preference for anticoagulants are: no food / drug interaction,no regular monitoring of blood indexes,no need for bridging,once daily intake and low cost.whether there are specific antagonists has no effect on the choice of patients.There were differences in the choice of anticoagulant preference attributes among different age,sex,residence,concomitant disease and atrial fibrillation.