Patients with atrial fibrillation likely to underestimate bleeding risks of anticoagulants
Women were significantly less likely than men to underestimate their bleeding risk, and a history of bleeding was associated with a threefold increased likelihood of inaccurate perception of bleeding risk, according to a study of atrial fibrillation patients.
More than two-thirds of patients with atrial fibrillation on oral anticoagulants underestimated their bleeding risk, and those with a history of bleeding and several comorbid conditions were more likely to do so, a recent study found.
Researchers used the Systematic Assessment of Geriatric Elements in Atrial Fibrillation study to compare patients' self-reported bleeding risk perceptions with their predicted bleeding risk according to the HAS-BLED score. This prospective cohort study included patients ages 65 years or older with atrial fibrillation and a CHA2DS2-VASc risk score of 2 or higher on oral anticoagulants. Results were published by the Journal of the American Heart Association on Aug. 16.
Sixty-eight percent of the study's 754 participants underestimated their bleeding risk. Women were significantly less likely than men to underestimate their bleeding risk (odds ratio [OR], 0.62; 95% CI, 0.46 to 0.85). Underestimation was more common among patients who were married or living as married (OR, 1.49; 95% CI, 1.09 to 2.03), had a history of bleeding (OR, 3.30; 95% CI, 1.97 to 5.50), or had higher CHA2DS2-VASc scores (OR, 1.33; 95% CI, 1.19 to 1.48). Patients were more likely to underestimate their bleeding risk if they had comorbidities of heart failure (OR, 1.41; 95% CI, 1.01 to 1.97), peripheral vascular disease (OR, 1.90; 95% CI, 1.15 to 3.16), hypertension (OR, 5.26; 95% CI, 3.15 to 8.76), stroke (OR, 7.02; 95% CI, 2.79 to 17.66), anemia (OR, 1.52; 95% CI, 1.07 to 2.15), or renal disease (OR, 5.31; 95% CI, 3.30 to 8.54). After multivariable adjustment, participants who were Asian or Pacific Islander, Black, Native American or Alaskan Native, multiracial, or Hispanic (non-White) were significantly less likely to underestimate their bleeding risk than White participants (adjusted OR, 0.45; 95% CI, 0.24 to 0.82).
Clinicians should consider educational strategies that strengthen their relationships with patients to correct perceptions of bleeding risk, according to the study authors. “Our findings suggest that patient education efforts to improve their overall knowledge about atrial fibrillation may not be enough to ensure accurate bleeding risk perceptions,” they wrote. “However, improved patient engagement through processes such as shared decision making, which aim to build provider-patient relationships, may be useful in aligning patient bleeding risk perceptions with their predicted risk and thereby reducing the potential for serious adverse drug events from [oral anticoagulants].”