Blood cellPatients with higher education benefit more from blood thinning medications, a new study by the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) has revealed.

The poll of more than 1,100 with atrial fibrillation found that patients with no schooling missed treatment targets more often, were less aware of bleeding risks and were unsure as to what daily activities they could partake in. However, 80% of university educated patients knew they could drive, play sports and travel by plane compared to 52% without schooling.

In total, 1,147 patients with atrial fibrillation and taking oral anticoagulation completed 40 questions online. Oral anticoagulation included the vitamin K antagonists (such as warfarin) and the non-vitamin K oral anticoagulants (NOACs), with responses collated over a 3-month period. On average, patients were 66 years old, while 46% of respondents were women. Patients were from eight countries: France (33.6%), Denmark (26.6%), Sweden (20.9%), Spain (7.7%), Norway (4.5%), Germany (3.7%), the UK (2.2%) and Italy (0.8%).

The study attempted to understand how much the patients knew about their medication. For example, patients taking vitamin K antagonists are advised to keep their international normalised ratio (INR) level, which indicates how long it takes blood to form a clot, between 2 and 3. Patients with no schooling were more likely to exceed the upper limit several times a month compared to those with college or university education (5.1% vs 2.8%).

Awareness of the bleeding risks associated with anticoagulant drugs was lowest in patients without schooling (38.5%) and highest in those with college and university education (57%). Nearly 1 in 4 (23%) patients without schooling reported having bleeding events associated with their medication compared to 18.7% with college and university education. Patients without schooling also had a higher rate of previous stroke (2.6%) than those with college and university educations (0.71 %). 

Professor Carina Blomström-Lundqvist, who led the survey and is final author of the paper, said: “The survey shows that differences in patient education level may compromise the safety and efficacy of anticoagulants. Patients unaware of the importance of being compliant have a higher risk for both bleeding events and stroke. The findings underline the importance of providing user-friendly education about risk factors for stroke and adequate use of anticoagulants, and the importance of tailoring the educational message to the target population so that it is understood irrespective of the patient’s level of schooling.”

Taking the patient group as a whole, when asked about the purpose of their anticoagulation medication, the majority (91–94%) correctly understood that it was to “thin the blood” but 6–9% incorrectly said it was to control the arrhythmia. Professor Blomström-Lundqvist said: “The survey demonstrated that a significant percentage of patients (around 8%) did not even understand the purpose of anticoagulation correctly and surprisingly, the number of patients who were aware of NOACs was still quite small.

“This survey has important implications as it shows not only the need for more education in general about the indication and use of anticoagulants in patients with atrial fibrillation, but importantly also that differences in educational level among patient populations may significantly compromise the safety and efficacy of anticoagulants.”

The findings were published in Europace.