Perception of the Risk of Stroke and the Risks and Benefits of Oral Anticoagulation for Stroke Prevention in Patients With Atrial Fibrillation: A Cross-Sectional Study

Objective: To assess the perception of the risk of stroke and the risks and benefits of oral anticoagulation (OAC)in patients with atrial fibrillation (AF). Patients and Methods: Consecutive patients with chronic AF who presented for an outpatient cardiology visit or were admitted to a noncritical care cardiology ward service from September 15 through December 20, 2017, were invited to participate in this survey. Participants were asked to estimate their stroke risk without OAC and bleeding risk with OAC using a quantitative risk scale. The reported values were compared with subjectively estimated risks derived from the CHA₂DS₂-VASc and HAS-BLED scores. Similarly, we compared patient perception of the stroke risk reduction afforded with OAC compared with what is reported in the literature. Results: A total of 227 patients were included in the analysis. The mean ± SD CHA₂DS₂-VASc score was 4.3±1.6, and HAS-BLED score was 2.3±1.2. Atrial fibrillation was paroxysmal in 53.3% and persistent/permanent in 46.7%. There was a negligible correlation between patient perceived and estimated risk of stroke (r=0.07; P=.32), and bleeding (r=0.16; P=.02). Most patients overestimated their risks of stroke and bleeding: 120 patients (52.9%)perceived an annual stroke risk greater than 20%, and 115 (53.5%)perceived an annual bleeding risk with OAC greater than 10%. Most patients (n=204; 89.9%)perceived that OAC would reduce their annual stroke risk by at least 50%. Conclusion: Perceived risks of stroke and bleeding are markedly overestimated in most patients with AF. Further research is needed to discern the root causes and to identify effective methods of bridging this alarming disparity.