The Effect Of Evidence-based Anticoagulant Risk Education On Knowledge,uncertainty In Illness And Adherence To Anticoagulant Therapy In Patients With Atrial Fibrillation

Part 1 Risk of anticoagulant therapy for patients with atrial fibrillation:a meta-analysis and systematic reviewObjective:This study used a meta-analysis and systematic review method to comprehensively search randomized controlled trials(RCTs)of anticoagulant therapy in patients with atrial fibrillation,and collected the risk information of anticoagulant therapy,which in order to supply the evidence-based basis for anticoagulant risk education in patients with atrial fibrillation.Methods:Pubmed,EMbase and Cochrane Central Register of Controlled Trials databases were searched from inception to November 30,2017 to collect randomized controlled trials of anticoagulant therapy in patients with atrial fibrillation.Risk of bias assessment from Cochrane Handbook 5.0 was used to assesse the quality of the included studies,and RevMan5.3 software was adopted to analyze the extracted data.Results:Nine RCTs were included in this study,including one article explored the safety of NOAC versus aspirin and eight papers with warfarin and aspirin or placebo for patients with AF.The results of Meta analysis shows that compared with no anticoagulant therapy,although warfarin increased the risk of bleeding events[OR=2.06,95%CI(1.54,2.76),P<0.001],there was no statistically significant difference in major hemorrhage events[OR=1.16,95%CI(0.74,1.84),P=0.51]and vascular death events[OR=0.78,95%Cl(0.36,1.70),P=0.53]between anticoagulant therapy and no anticoagulant therapy.In addition,anticoagulant therapy of warfarin significantly decreased the risk of thromboembolic events in patients with atrial fibrillation[OR=0.48,95%CI(0.37,0.62),P<0.001].Conclusion:In view of the fact that minor bleeding events can be prevented in time,and there is no significant increase in major bleeding and vascular death events,and embolic events are significantly reduced,regular anticoagulant therapy is relatively safe and effective for patients with atrial fibrillation.Part 2 Construction and preliminarily application of an evidence-based anticoagulant risk education program for patients with atrial fibrillationObjective This study aimed to explore the effect of evidence-based anticoagulant risk education on knowledge,uncertainty in illness and adherence to anticoagulant therapy in patients with atrial fibrillation.Methods This study was a prospective randomized controlled trial.(1)The specific risk of thromboembolic,bleeding and vascular death events in patients with atrial fibrillation received anticoagulant therapy,combined with the guidelines for the management of atrial fibrillation and clinical knowledge,and though two rounds of expert consultation and opinions of five patients who met the inclusion and exclusion criteria,the final draft of general education manual and the evidence-based anticoagulant risk education manual for atrial fibrillation were formed.(2)From June to December 2018,patients who met the inclusion and exclusion criteria were recruited and randomly allocated to the control group(N=26)and the intervention group(N=26)according to the random number table.All patients received regular education.The patients in the intervention group received evidence-based anticoagulant risk education.The intervention lasted I month.All patients received scheduled telephone or WeChat visits(1 time/w)until the end of the study.Anticoagulant knowledge,uncertainty in illness and adherence to anticoagulant therapy were collected and compared at baseline as well as 1-month.Also the occurrences of bleeding and thromboembolic events in both groups were recorded and analyzed.Results1.Construction of an evidence-based anticoagulant risk education program for patients with atrial fibrillation1.1 The evidence-based anticoagulant risk education manual for patients with atrial fibrillationThe evidence-based anticoagulant risk education manual includes four aspects:the performance of atrial fibrillation,the risk of atrial fibrillation,the benefits and risks of anticoagulant therapy and the precautions for anticoagulant therapy.Importantly,the benefits and risks of anticoagulant therapy aspect is presented as specific data,and this content is shown in bold and red fonts,which fully highlighting the importance of risk education.In addition to showing that anticoagulant therapy can reduce the risk of embolism but increase the risk of bleeding,the rest contents of the general anticoagulation education manual for patients with atrial fibrillation is the same as the evidence-based atrial fibrillation risk education manual.1.2 The evidence-based anticoagulant risk education program for patients with atrial fibrillationThe researcher gave a one-month evidence-based anticoagulant risk education to patients with atrial fibrillation.During the hospitalization,the researcher conducted evidence-based anticoagulant risk education for patients with atrial fibrillation,distributed the evidence-based anticoagulant risk education manual,and focused on the specific data of anticoagulant therapy,which may be need about 20 to 30 minutes.After discharge,the patients were followed up by telephone,supplemented by WeChat follow-up to strengthen the risk of,explain the importance of anticoagulant therapy,and urged to take the medicine on time and follow up on time,and it may be need about 10 minutes each time.The control group conducted the general anticoagulation education of atrial fibrillation and distributed the general anticoagulation education manual for patients with atrial fibrillation.2 The effect of evidence-based anticoagulant risk education on knowledge,uncertainty in illness and adherence to anticoagulant therapy in patients with atrial fibrillationDuring one month,3 cases in the control group and 5 cases in the intervention group were excluded respectively.Finally,there were 23 cases in the control group and 21 cases in the intervention group.There was no significant difference on the baseline data of the patients included in the two groups(P>0.05).2.1.Anticoagulant knowledge(1)At the end of intervention,the level of anticoagulant knowledge in the intervention group was significantly higher than that in the control group(t=-3.069,P<0.05).Meanwhile,the mean difference of anticoagulant knowledge between two groups showed a statistically difference(t=-3.166,P<0.05).(2)The results of intra-group comparison showed the level of anticoagulant knowledge at the end of study was higher than those at the baseline in the two groups(P<0.05).2.2 Uncertainty in illness(1)At the end of intervention,the level of uncertainty in illness in intervention group was significantly lower than that in the control group(?~2=4.859,P<0.05).(2)The results of the intra-group comparison indicated evidence-based anticoagulant risk education significantly reduced the level of uncertainty in illness in patients with atrial fibrillation(P<0.05),while the same finding did not show in the control group(P>0.05).2.3 Risk communication satisfactionAfter one month intervention,although there was no significant difference in risk communication satisfaction between two groups(P>0.05).However,The results of the intra-group comparison presented that the level of risk communication satisfaction at the end of study was significantly higher than that at baseline in two groups(P<0.05).2.4 Adherence to anticoagulant therapyAfter the intervention,(1)Although the level of adherence to anticoagulant therapy showed an increased trend in intervention group than that in the control group,the results showed there were no significant difference between two groups(the intervention group versus the control group=76.2%vs 47.8%,?~2=3.725,P=0.054).(2)The number of patients with good adherence to anticoagulant therapy increased in both groups,but there was a significant difference only in the intervention group(P<0.05).2.5 Safety eventsDuring intervention period,four bleeding events occurred,three in the control group and one in the intervention group.No thromboembolic events occurred.Conclusion The study successfully developed an evidence-based anticoagulation risk education program and it can improve the level of anticoagulant knowledge,reduce the level of uncertainty in Illness in patients with atrial fibrillation,which have certain reference and guiding significance for clinical nursing work.Although this program failed to improve the compliance of anticoagulation therapy,it has a significant improvement trend and the study time is short.Future studies can extend the intervention time and expand the sample size to explore the improvement of anticoagulation therapy compliance in patients with atrial fibrillation based on evidence-based anticoagulation risk education.