Objectives To explore and reflect on the current anticoagulation therapy offered to patients with atrial fibrillation (AF), potential challenges and the future vision for oral anticoagulants for patients with AF and healthcare professionals in Ireland.
Design A multistakeholder focus group using a World Café approach.
Participants Nine participants from academic, clinical and health backgrounds attended the focus group together with a facilitator.
Results Enhanced patient empowerment; more effective use of technology and developing system-based medical care pathways would provide improved supports for AF management. The challenges in providing these include cost and access issues, the doctor–patient relationship and the provision of education. While consensus for developing evidence-based pathways to maximise efficiency and effectiveness of AF treatment was evident, it would require a shared vision between stakeholders of integrated care. The benefits of embracing technological advances for clinicians and patients were evident; however, clinicians indicate this can increase pressure on already stretched resources; coupled with institutional barriers (including scarce resources) arising from the complex nature of anticoagulation for patients with AF, which emerged strongly. Including the unpredictable nature of warfarin, hidden costs associated with monitoring, adverse clinical effects, different patient cohorts (including those prescribed anticoagulant for the first time vs those switching from warfarin to a new oral anticoagulant (NOAC)), non-adherence concerns and undesirable impacts on patients’ daily lives.
Conclusions While anticoagulation therapy for patients with AF using NOACs has been widely adopted and is diffusing into routine practice, significant operationalisation issues and barriers to effective treatment/management persist. The reflections reported in this study are a catalyst for future discussion and research.
- adult cardiology
- protocols & guidelines
- qualitative research
- stroke medicine
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Contributors AM, AK and CB made substantial contributions to the conception and design of the work. POR made substantial contributions to design of the work. AM, SB and SMC made substantial contributions to analysis, interpretation of data and drafting the manuscript. All authors contributed to revising the work critically for important intellectual content and approved the final version.
Funding This work was supported by the College of Business and Law Strategic Research Fund at University College Cork.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Patient consent for publication Not required.
Ethics approval Due to the anonymised nature of the evidence presented in the study, this research carries little to no risk to participants. No ethical approval was sought to hold the World Café. After the event, we emailed participants to make them aware that we were going to write up a reflection of the event for publication. The writing does not identify or compare the contributions of individual attendees. The right of all participants to confidentiality was maintained, including secure data storage.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request from the corresponding author. ORCID 0000-0003-3062-0692.
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