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The Impact of Long-term Warfarin Therapy on Quality of Life: Evidence From a Randomized Trial

The Impact of Long-term Warfarin Therapy on Quality of Life: Evidence From a Randomized Trial Abstract To determine the effect of long-term warfarin sodium therapy on quality of life, we surveyed 333 patients participating in a randomized, controlled trial of warfarin for the prevention of stroke in nonrheumatic atrial fibrillation. No significant differences between warfarin-treated and control patients were found on well-validated measures of functional status, well-being, and health perceptions. For example, the summary score for health perceptions was 68.8 in the warfarin-treated vs 66.6 in the control group (scale of 0 to 100; 95% confidence intervals for the difference, —1.6 to 6.0). In contrast, patients taking warfarin who had a bleeding episode had a significant decrease in health perceptions (-11.9; 95% confidence interval, —4.1 to — 19.6 Warfarin therapy is not usually associated with a significant decrease in perceived health, unless a bleeding episode has occurred. Negative effects of warfarin treatment on health perceptions may be balanced by confidence in its protective effects. (Arch Intern Med. 1991;151:1944-1949) References 1. Petersen P, Boysen G, Godtfredsen J, Andersen ED, Andersen B. Placebo-controlled, randomized trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation: the Copenhagen AFA-SAK Study . Lancet. 1989;1:175-179.Crossref 2. Stroke Prevention in Atrial Fibrillation Study Group Investigators. Preliminary report of the Stroke Prevention in Atrial Fibrillation study . N Engl J Med. 1990;322:863-868.Crossref 3. The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. The effect of low dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation . N Engl J Med. 1990;323:1505-1511.Crossref 4. Croog SH, Levine S, Testa MA, et al. The effects of antihypertensive therapy on quality of life . N Engl J Med. 1986;314:1657-1664.Crossref 5. Haynes RB, Sackett DL, Taylor DW, et al. Increased absenteeism from work after detection and labelling of hypertensive patients . N Engl J Med. 1978;299:741-744.Crossref 6. Monk M. Psychologic status and hypertension . Am J Epidemiol. 1980;112:200-208. 7. Siscovick DS, Strogatz DS, Fletcher SW, Leake B, Brook RH. The association between hypertension treatment, control and functional status . J Gen Intern Med. 1987;2:406-410.Crossref 8. Tsevat J, Eckman MH, McNutt RA, Pauker SG. Warfarin for dilated cardiomyopathy: a bloody tough pill to swallow? Med Decis Making. 1989;9:162-169.Crossref 9. Stewart AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions: results from the Medical Outcome Study . JAMA. 1989;262:907-913.Crossref 10. Ware JE. Standards for validating health measures: definition and content . J Chronic Dis. 1987;40:473-480.Crossref 11. Stewart AL, Hays RD, Ware JE. Health perceptions, energy/fatigue, and health distress measures . In: Stewart AL, Ware JE, eds. Measuring Function and Well-Being: The Medical Outcomes Study Approach . Durham, NC: Duke University Press. In press. 12. Ware JE. The General Health Rating Index . In: Wenger NK, Mattson ME, Furberg CD, Elinson J, eds. Assessment of Quality of Life in Clinical Trials of Cardiovascular Disease . New York, NY: Lejacq Publishing Co; 1984:87-111. 13. SAS Institute Inc. SAS/STAT Guide for Personal Computers , Version 6 Edition. Cary, NC: SAS Institute Inc; 1987. 14. Rosner B. Fundamentals of Biostatistics . Boston, Mass: Duxbury Press; 1986:250. 15. Chang HJ, Bell JR, Deroo DB, et al. Physician variation in anticoagulating patients with atrial fibrillation . Arch Intern Med. 1990;150:83-86.Crossref 16. Bucknall CA, Morris GK, Mitchell JR. Physicians' attitudes to four common problems: hypertension, atrial fibrillation, transient ischaemic attacks, and angina pectoris . BMJ. 1986;293:740-742. 17. Canadian Erythropoietin Study Group. Association between recombinant human erythropoietin and quality of life and exercise capacity of patients receiving haemodialysis . BMJ. 1990;300:573-578.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

The Impact of Long-term Warfarin Therapy on Quality of Life: Evidence From a Randomized Trial

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400100032005
Publisher site
See Article on Publisher Site

Abstract

Abstract To determine the effect of long-term warfarin sodium therapy on quality of life, we surveyed 333 patients participating in a randomized, controlled trial of warfarin for the prevention of stroke in nonrheumatic atrial fibrillation. No significant differences between warfarin-treated and control patients were found on well-validated measures of functional status, well-being, and health perceptions. For example, the summary score for health perceptions was 68.8 in the warfarin-treated vs 66.6 in the control group (scale of 0 to 100; 95% confidence intervals for the difference, —1.6 to 6.0). In contrast, patients taking warfarin who had a bleeding episode had a significant decrease in health perceptions (-11.9; 95% confidence interval, —4.1 to — 19.6 Warfarin therapy is not usually associated with a significant decrease in perceived health, unless a bleeding episode has occurred. Negative effects of warfarin treatment on health perceptions may be balanced by confidence in its protective effects. (Arch Intern Med. 1991;151:1944-1949) References 1. Petersen P, Boysen G, Godtfredsen J, Andersen ED, Andersen B. Placebo-controlled, randomized trial of warfarin and aspirin for prevention of thromboembolic complications in chronic atrial fibrillation: the Copenhagen AFA-SAK Study . Lancet. 1989;1:175-179.Crossref 2. Stroke Prevention in Atrial Fibrillation Study Group Investigators. Preliminary report of the Stroke Prevention in Atrial Fibrillation study . N Engl J Med. 1990;322:863-868.Crossref 3. The Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators. The effect of low dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation . N Engl J Med. 1990;323:1505-1511.Crossref 4. Croog SH, Levine S, Testa MA, et al. The effects of antihypertensive therapy on quality of life . N Engl J Med. 1986;314:1657-1664.Crossref 5. Haynes RB, Sackett DL, Taylor DW, et al. Increased absenteeism from work after detection and labelling of hypertensive patients . N Engl J Med. 1978;299:741-744.Crossref 6. Monk M. Psychologic status and hypertension . Am J Epidemiol. 1980;112:200-208. 7. Siscovick DS, Strogatz DS, Fletcher SW, Leake B, Brook RH. The association between hypertension treatment, control and functional status . J Gen Intern Med. 1987;2:406-410.Crossref 8. Tsevat J, Eckman MH, McNutt RA, Pauker SG. Warfarin for dilated cardiomyopathy: a bloody tough pill to swallow? Med Decis Making. 1989;9:162-169.Crossref 9. Stewart AL, Greenfield S, Hays RD, et al. Functional status and well-being of patients with chronic conditions: results from the Medical Outcome Study . JAMA. 1989;262:907-913.Crossref 10. Ware JE. Standards for validating health measures: definition and content . J Chronic Dis. 1987;40:473-480.Crossref 11. Stewart AL, Hays RD, Ware JE. Health perceptions, energy/fatigue, and health distress measures . In: Stewart AL, Ware JE, eds. Measuring Function and Well-Being: The Medical Outcomes Study Approach . Durham, NC: Duke University Press. In press. 12. Ware JE. The General Health Rating Index . In: Wenger NK, Mattson ME, Furberg CD, Elinson J, eds. Assessment of Quality of Life in Clinical Trials of Cardiovascular Disease . New York, NY: Lejacq Publishing Co; 1984:87-111. 13. SAS Institute Inc. SAS/STAT Guide for Personal Computers , Version 6 Edition. Cary, NC: SAS Institute Inc; 1987. 14. Rosner B. Fundamentals of Biostatistics . Boston, Mass: Duxbury Press; 1986:250. 15. Chang HJ, Bell JR, Deroo DB, et al. Physician variation in anticoagulating patients with atrial fibrillation . Arch Intern Med. 1990;150:83-86.Crossref 16. Bucknall CA, Morris GK, Mitchell JR. Physicians' attitudes to four common problems: hypertension, atrial fibrillation, transient ischaemic attacks, and angina pectoris . BMJ. 1986;293:740-742. 17. Canadian Erythropoietin Study Group. Association between recombinant human erythropoietin and quality of life and exercise capacity of patients receiving haemodialysis . BMJ. 1990;300:573-578.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 1, 1991

References