Application-Delivered Patient Education in Enhancing the Usage of Apixaban in Patients With Atrial Fibrillation

Summary

"AF is the most common arrhythmia, with an overall prevalence of approximately 2%. It is particularly prevalent in individuals over 60 years old, affecting about 5% of this population. With the aging population, the global prevalence of AF is increasing. In South Korea, the overall prevalence of AF increased from 0.73% in 2006 to 1.53% in 2015, a 2.1-fold increase. By 2060, it is projected that 2.3 million people in Korea will have AF, with a prevalence rate of 5.81%. AF accounts for approximately 20% of all ischemic strokes, and patients with AF have an annual risk of ischemic stroke ranging from 6% to 10%. Additionally, AF can lead to heart failure and doubles the mortality rate. Despite various treatment options, the mortality rate associated with AF continues to rise annually.

Anticoagulation therapy for the prevention of thromboembolism in AF is a crucial treatment approach. Traditional warfarin therapy has been shown to reduce the risk of stroke by approximately 63%. Recently developed non-vitamin K oral anticoagulants (NOACs) have demonstrated similar efficacy to warfarin while offering a lower risk of hemorrhagic complications, particularly intracranial hemorrhage, making them a safer alternative.

Adherence to anticoagulant therapy is crucial for the effective prevention of stroke in patients with AF. Poor adherence to anticoagulants significantly increases the risk of thromboembolic events, including ischemic stroke. Studies have shown that patients with low adherence to anticoagulation therapy experience higher rates of stroke and mortality compared to those who consistently take their medication as prescribed. Ensuring proper adherence to anticoagulants, whether traditional warfarin or newer non-vitamin K oral anticoagulants (NOACs), is essential to maximizing treatment benefits while minimizing complications. Factors influencing adherence include medication side effects, complexity of the treatment regimen, patient awareness, and regular follow-up with healthcare providers. Strategies to improve adherence, such as patient education, simplified dosing regimens, and routine monitoring, play a key role in reducing the burden of AF-related strokes.

The burden of cardiovascular risk factors, including lifestyle factors and borderline conditions, as well as comorbidities, significantly influences both the risk of AF development and its prognosis. The continuum of unhealthy lifestyle habits, risk factors, and cardiovascular diseases contributes to atrial remodeling, cardiomyopathy, and ultimately, the onset of AF through the combined effects of multiple interacting factors. One of the three core components of the Atrial Fibrillation Better Care (ABC) pathway for comprehensive AF management is the ""C"" component, which focuses on the identification and management of comorbidities, cardiometabolic risk factors, and unhealthy lifestyle habits. Effective management of these risk factors and cardiovascular diseases plays a crucial role in stroke prevention and in reducing AF burden and symptom severity. Recent randomized clinical trials have shown that targeted treatment of underlying conditions improves the maintenance of sinus rhythm following AF ablation in patients with persistent AF and heart failure.

Education by healthcare providers regarding medication adherence and risk factor management for existing AF patients is often limited due to constraints in manpower and resources. However, leveraging new technologies such as mobile applications can help overcome these limitations by enhancing patient education and improving medication adherence without the need for additional healthcare personnel.

This study is fundamentally a prospective, multicenter, randomized, open-label clinical trial. Patients with atrial fibrillation who are prescribed edoxaban at participating institutions will be randomly assigned to either an app-based anticoagulation education group or a non-education group. Primary objective is to demonstrate that an app-based education program for patients with AF taking apixaban results in a lower incidence of major cardiovascular events (ischemic stroke/systemic embolism, major bleeding, hospitalization, myocardial infarction, and death) compared to the non-education group. Secondary Objective is to investigate the impact of the intervention on secondary events, including stroke, systemic embolism, transient ischemic attack (TIA), major bleeding, non-major bleeding, hospitalization, myocardial infarction, death, and medication adherence. Exploratory Objective are to assess treatment satisfaction using the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire, and to evaluate cognitive function changes using the Korean Dementia Screening Questionnaire (KDSQ).

Conditions

• Atrial Fibrillation on Apixaban Treatment

Interventions

OTHER

AF application enhancing AF education and drug adhrence

This group will use AF-application. The app will include content related to anticoagulation therapy, such as: medication reminders or intake confirmation for anticoagulants, the importance of anticoagulation therapy in stroke prevention, the role of antiarrhythmic and rate-control medications in symptom management, the necessity of controlling risk factors such as hypertension, diabetes, and hyperlipidemia, and quality of life and cognitive function assessments through questionnaires.

OTHER

AF application without enhancing AF education and drug adhrence

This group will use AF-application. However, this application will not contain materials enhancing AF education and adherence.

Sponsors & Collaborators

• Yonsei University

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

19 Years

Max Age

90 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-03-31

Primary Completion

2030-02-28

Completion

2030-07-31

Countries

• South Korea

Study Locations