L’aderenza al tra,amento an/coagulante nel ... - SMC Media · Pa#ent educa#on on the relevance of...

ANTICOAGULAZIONE:attualità cliniche, di laboratorio e aspetti sociali

BOLOGNA, 21-22 GENNAIO 2016

L’aderenzaaltra,amento

an/coagulantenelpazienteconFA

DanielaPoliBologna21-22Gennaio2016

PersistenceThelengthof/mebetweenini/a/onanddiscon/nua/on

ofatreatment.

ComplianceTheextenttowhichmedicalrecommenda/ons

arefollowedasdefined,withpa/ent’spassiveobediencetothephysician’sinstruc/ons.

‘Acomplexbehaviouralprocess,stronglyinfluencedbytheenvironmentinwhichthepa/entslive,howhealthcareprovidersprac/ce,andhowhealthcaresystemsdelivercare’AmericanHeartAssocia/on,1997

AdherenceImpliescoopera/onbetweenpa/entandprescriber.



ThrombRes2014

ThrombRes2014



JTH,2015

JTH,2015



JTH,2015

- Morethan75%ofpa/entsadheredtodabigatran>80%ofthe/me

- Pa/entsathighrisk(CHA2DS2-VAScscore≥2)weresignificantlymoreadherentthanlowriskpa/ents

- Pa/entswithpriorbleedingwerelessadherent

- Regularcontactwiththehealthcaresystemandpa/entsunderstandingmayimproveadherence.

EUROPACE,2015Discon/nua/onrate15%inthefirstyear



EUROPACE,2015

ShoreSetal.AmHeartJ,2014

28%ofpa/entspooradherent



ShoreSetal.AmHeartJ,2014

Conclusions…Theadvantagesofdabigatranrela/vetowarfarinintermsoflaboratorymonitoringandreducedinterac/onsmustbeweighedagainsttheimplica/onsofnon-adherenceonpa/entoutcomes.

CerebrovascularDisease,2015

ConclusionsInstrokeandTIApa/entswithAF,themul/factorialmedicalandfunc/onalconstella/onratherthancogni/veimpairmentspecificallycanbeanobstacleforlong-termOAC.



EUROPACE,2014

EUROPACE,2014



HedbuchelHetal.Europace,2015


1. Pa#ent educa#on on the relevance of strict adherence is of utmostimportance. Many simultaneous approaches should be employed in thisregard: leaflets and instruc/ons at ini/a/on of therapy; a pa/entan/coagula/on card; group sessions; re-educa/on at every prescrip/onrenewal.Severalorganiza/onsalsoofferonlinepa/entsupportwebsites,including EHRA (h,p://www.afibma,ers.org/), the AF Associa/on in the UK(h,p://www.atrialfibri l la/on.org.uk/) , An/coagula/on Europe (h,p://www.an/coagula/oneurope.org/)2. Family members should be involved in this educa/on, so that they canunderstandthe importanceofadherence,andhelpthepa/ent inthisregard.professionals providing care. Each of those actors has responsibility toreinforceadherence.Nurse-coordinatedAFcentresmaybehelpfulincoordina/ngpa/entfollow-upandcheckingonadherence.




3.Manytechnologicalaidsarebeingexploredtoenhanceadherence:theformatoftheblisters;medica/onboxes(conven/onalorwithelectronicverifica/onofintake);smartphoneapplica/onswithremindersand/orSMSmessagestoalertthepa/entaboutthenextintakesomeevenrequiringconfirma/onthatthedosehasbeentaken.Again,thelongtermeffectsofsuchtoolsareunknownandonetoolmaynotsuitallpa/ents.Theprescribingphysician,however,shouldconsiderindividualiza/onoftheseaids.4.AnODdosingregimenwasrelatedtogreateradherencevs.BIDregimensincardiovascularpa/ents,andinAFpa/ents(fordiabetesandhypertensiondrugs).


5.Somepa/entsmayexplicitlypreferINRmonitoringtonomonitoringorNOACoverVKAtherapy.Pa/enteduca/onneedstodiscussthesepreferencesbeforestar/ng/conver/ngtoNOACtherapyandmanagementdecisionshavetotakethesepreferencesintoaccounttoop/mizehealthoutcomes.6.InNOACpa/entsinwhomlowadherenceissuspecteddespitepropereduca/onandaddi/onaltools,conversiontoVKAs(preferablywithlonghalf-lifelikephenprocoumon)couldbeconsidered.



AEGEANobjec/vesPrimaryObjec#ve:•  Toassesstheimpactofaneduca/onalprogramonimplementa/onphase

adherenceinpa/entstakingapixabanforSPAF.Assessedat24weeksamerini/a/onusinganEMD,HelpingHand®

SecondaryObjec#ves:•  Toassesstheimpactofaneduca/onalprogramonpersistenceat24

weeksinpa/entstakingapixaban•  Toiden/fypredic/veriskfactorslinkedtonon-adherenceinpa/ents

treatedwithapixaban•  Toevaluateimpactofaneduca/onalprogramonefficacy/safetyprofileof

apixaban

EMD,electronicmonitoringdevice;SPAF,strokepreven/oninatrialfibrilla/on

Adherence(primaryendpoint)

94,32 92,30 88,5193,88 91,80 88,340102030405060708090100110

Week4 Week12 Week24

StandardofCare(n=583)Addi/onalEduca/onalProgramme(n=579) p=0.89

*

Adherence(%)

*PrimaryEndpoint(24weeks)



CostaEetal.2015

Poor adherence is associatedwith highhealth care costs, lowerqualityoflife,andpoorhealthoutcomes.Medica/on adherence remains a challenge for health careprofessionalandscien/sts,astheireffortstoimproveandexplainpa/ents’adherenceappeartobeineffec/ve.A lot of interven/ons to improve adherence to medical planshavebeendescribedinliterature,despitesomeisolatedsuccess,mostinterven/onsfailedintheiraims.

TheCochraneCollabora/on,2014

MainresultsThisreviewincluded26studiesinvolving8021par/cipants.Therewerenosignificanteffectsoforganisa/onalinterven/onsmedica/onadherenceorrecurrentcardiovascularevents.Educa/onalandbehaviouralinterven/onswerenotgenerallyassociatedwithcleardifferencesinanyofthereviewoutcomes,withonlytwoexcep/ons.Authors’conclusionsPooledresultsindicatedthateduca/onalinterven/onswerenotassociatedwithcleardifferencesinanyofthereviewoutcomes.Thees/matedeffectsoforganisa/onalinterven/onswerecompa/blewithimprovementsandnodifferencesinseveralmodifiableriskfactors.Weiden/fiedalargenumberofongoingstudies,sugges/ngthatresearchinthisareaisincreasing.



G.AM;Fanni66indicazioneallaTAO: TEVrecidivante

Valvuloplas/camitralica Pregressostroke

11/2011iniziawarfarinINR2.0-3.0passaaSintromperelevatofabbisognomaggio2013tornaawarfarinfinoalgiugno2013: tempoinrange 34%

temposo,orange37% temposoprarange29%

12volte/18mesiINR>4.0

G.AMFanni66Luglio2013siproponepassaggioadabigatranchelapazienterifiutadal8/2013adoggi: tempoinrange69%

temposo,orange18% temposoprarange19%

1volta/18mesiINR>4.0

L’aderenza al tra,amento an/coagulante nel ... - SMC Media · Pa#ent educa#on on the relevance of...

Documents

Transcript of L’aderenza al tra,amento an/coagulante nel ... - SMC Media · Pa#ent educa#on on the relevance of...