Oral anticoagulants (OAC) significantly reduce the risk of thromboembolism in patients with nonvalvular atrial fibrillation. In addition to oral anticoagulation with the traditional vitamin K antagonists (VKA), for the past few years, new oral anticoagulants (NOAC) have been available, whose efficacy and safety are at least similar to those of VKA.1 One of the advantages of these drugs lies in the stability of their anticoagulant action, obviating the need for systematic follow-up and thus making them more convenient for patients to use. It is important to determine patients’ opinion of the treatment and care provided to them, but this is often overlooked. The objective of our study was to analyze satisfaction among patients with nonvalvular atrial fibrillation with OAC-related medical care and to compare those receiving VKA or NOAC. To do this, we studied the first 1247 patients included in the FANTASIIA registry.2 This per-protocol analysis included consecutive patients treated with VKA and NOAC (at a proportion of 4:1) who had received OAC for at least 6 months prior to the inclusion visit in 50 Spanish centers between June 2013 and March 2014. A total of 964 patients took VKA and 283 took NOAC. Their baseline characteristics are listed in Table 1. All the patients completed the SAFUCA questionnaire3 on satisfaction with medical care, which includes 25 items grouped under 7 domains (efficacy of medication, convenience of medication, anticoagulation monitoring, interference of the medication with daily life, undesirable effects, medical follow-up, and general satisfaction) (Table 2). Each item is scored from 0 to 4 (0 = not at all; 4 = a lot), which is integrated to obtain a global score of 0 to 100 for each domain and for a global summary of the score.3 In domains 1 (efficacy of medication), 2 (convenience of medication), 6 (medical follow-up) and 7 (general opinion on medication), the closer to 100 the score, the greater the satisfaction. For domains 3 (coagulation monitoring), 4 (interference of medication with daily life) and 5 (undesirable effects), the closer to 0 the score, the lower the degree of concern, but for the interpretation to be the same for all domains, and for the global score, the score was “normalised” for domains 3, 4 and 5 by inverting the score (100 minus the value obtained), so that for all domains, the closer to 100 the score, the greater the satisfaction (Table 2). This score had an adequate Cronbach's alpha (0.861) and had a high test-retest reliability coefficient (0.935) in previous studies.3 The global results and the results by OAC subgroups are listed in Table 2. Overall, satisfaction with the medical care was high (score of 74.74/100), and satisfaction was lowest for “coagulation monitoring”. In the OAC subgroups, the scores were significantly higher in all domains and the global score of patients with NOAC (Table 2). Therefore, it seems that satisfaction with medical care, or at least the perception of OAC in patients with nonvalvular atrial fibrillation receiving this treatment, is generally good; satisfaction was higher among patients receiving NOAC and was slightly lower, with statistically significant differences, among those who receiving VKA. The parameter with the worst score for patients taking VKA was the need for regular coagulation check-ups. This was also the case in patients taking NOAC, although satisfaction was significantly higher than with VKA. This finding was surprising, since these patients were not taking VKA and therefore, theoretically, did not require systematic anticoagulation monitoring. Despite the explanations given prior to distributing the questionnaire, these patients may have put themselves in the situation of when they needed check-ups (those who had previously taken VKA) or imagined that they would need them if they were to take VKA in the future.

These results indicate that it is necessary to determine patients’ perception of the care given and their satisfaction with this care, as well as the efficacy and safety of the treatments, as the findings may lead to better therapeutic adherence, which is always important, but even more so when using drugs that are difficult to control, such as OAC. It is therefore essential to have specific tools for atrial fibrillation, such as the SAFUCA questionnaire, and other validated quality of life scales for this disease.4