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1 I have no conflict of interest to declare

Geest, Tiny Jaarsma, Mattie Lenzen, Philip Moons, Jan Mårtensson, Karen

2 Kjersti Oterhals Department of Heart Disease, Haukeland University Hospital, Bergen, Norway UNITE Research Group; Christi Deaton, Sabina De Geest, Tiny Jaarsma, Mattie Lenzen, Philip Moons, Jan Mårtensson, Karen Smith, Simon Stewart, Anna Strömberg, David R. Thomson and Tone M. Norekvål 2

Oral anticoagulation therapy prevent thromboembolic complications Monitoring and patient adherence Wafarin-diet-drug-interactions Patient self-testing (PST) or selfmanagement (PSM) of INR Novel

3 Oral anticoagulation therapy prevent thromboembolic complications Monitoring and patient adherence Wafarin-diet-drug-interactions Patient self-testing (PST) or selfmanagement (PSM) of INR Novel anticoagulants Lack of knowledge among health-careprofessionals (Bloomfield et al. 2011, Gulseth et al 2012, Carrington et al. 2011, Christensen et al. 2003, Couris et al. 2006, Couris et al. 2000, Kimmel et al. 2007, Heneghan et al. 2012) 3

Investigate European cardiovascular nurses` knowledge and management of anticoagulation therapy: warfarin-drug interactions warfarin-food

4 Investigate European cardiovascular nurses` knowledge and management of anticoagulation therapy: warfarin-drug interactions warfarin-food interactions new anticoagulant therapies use of PST and PSM if level of education or years in clinical practice could affect the knowledge 4

Design: Survey Setting: Spring Meeting, Copenhagen 2012 Measurements: Questionnaire, 47 items demographic information (10 items) practice patterns

5 Design: Survey Setting: Spring Meeting, Copenhagen 2012 Measurements: Questionnaire, 47 items demographic information (10 items) practice patterns on oral anticoagulation use including INR self-monitoring (5items) oral anticoagulation with warfarin (28items) use of a new anticoagulant (4items) 5

6 Demographic variables n (%) Female 189 (92) Age (mean±sd) 42±9 Highest level of education Basic nurse training 82 (40) Bachelor degree 66 (32) Master degree 48 (23) PhD 10 (5) Current position Staff Nurse 102 (50) Advanced Practice Nurse 44 (21) Head nurse/nurse manager 27 (14) Other 32 (15) Direct patient contact 167 (84) Primary work environment Inpatient department 95 (48) Outpatient department 42 (21) Both inpatient and outpatient departments 46 (23) Community health 5 (3) Other 12 (6) Years of working in patient care (mean±sd) 17±9 Years of working in cardiovascular patient care 13±8 (mean±sd) Countries Denmark 133 (65) UK 13 (6,3) Netherlands 9 (4,4) Norway 9 (4,4) Sweden 7 (3,4) Others 35 (16,5) 6

7 Question n (%) Oral anticoagulants in use in daily practice (n=202) Warfarin (Marevan, Waran, Coumadin) 200 (99) Dabigatran (Pradaxa) 111 (54) Rivaroxaban (Xarelto) 4 (2) Will patients be offered a choice of drugs? (n=195) No, all patients will be put on warfarin first 74 (38) Some patients may be offered new anticoagulation 111 (57) Most patients will be given a choice 11 (6) Will patients on warfarin be able to change to one of the new drugs? (n=191) No, they will need to stay on warfarin 31 (16) May change if difficulties keeping INR in therapeutic range 133 (70) Any patient can change to one of the new drugs 27 (14) Do you offer patients INR self-testing or self-management? (n=195) Both self-testing and self-management of INR 69 (35) Only self-testing of INR 5 (3) Neither self-testing nor self-management of INR 113 (58) Never heard about self-testing or self-management of INR 8 (4) The role of nurses regarding anticoagulants in your country (n=197) Do not have a specific role 21 (11) Counsel patients regarding adherence to the drug regimen 57 (29) Advice patients on dosing warfarin based on INR results 91 (46) Teach about drugs, how to take them and side-effects 162 (82) 7

8 Possible maximum score: 53 Total score: 28±6; median 28 (range 3 to 41) Nurses in direct patient care 29±6 / nurses not in direct patient care 26±6 (p=0.011) Years in clinical practice did not affect the results Decrease of knowledge with increasing level of education (p=0.007, R 2 = 0.082) 8

9 56% Aspirin 7% 24% 13% Enhance Inhibit No effect Don`t know 9

10 55% 41% 2% 2% Enhance Inhibit No effect Don`t know 10

11 Antacids 65% 13% 17% 5% Enhance Inhibit No effect Don`t know 11

12 44% 31% 10% 15% Enhance Inhibit No effect Don`t know 12

13 49% 33% 12% 6% Enhance Inhibit No effect Don`t know 13

14 54% 32% 14% Yes No Don`t know 14

15 Should not eat spinach Can eat spinach once a month Can eat as much spinach he likes 5% 1% 11% Need to eat the same amont every week 79% Don`t know 4% 15

16 Decrease INR 18% Increase INR 63% No effect on INR 10% Makes patient sick 0 Don`t know 9% 16

17 At lunchtime 0 In the evening 71% In the morning, before breafast 4% Any time of day 23% Don`t know 2% 17

18 Skip the dose he missed 54% Take the missed dose right now 20% Take 2 doses in the evening 3% Take one-half of the dose right now Don`t know 12% 11% 18

19 European cardiac nurses have some improvement to make in the knowledge on oral anticoagulation therapy. High knowledge on warfarin-medication-diet interactions is important to deliver optimal care to cardiac patients. Patient education is a step toward improving safety of patients on oral anticoagulation therapy. 19

20 Christi Deaton (England) Sabina De Geest (Switzerland) Tiny Jaarsma (Sweden) Mattie Lenzen (The Netherlands) Philip Moons (Belgium) Jan Mårtensson (Sweden) Karen Smith (Irland) Simon Stewart (Australia) Anna Strömberg (Sweden) David R. Thompson (Australia) Tone M. Norekvål (Norway) 20

Education and practice gaps on atrial fibrillation and anticoagulation: a survey of cardiovascular nurses

Ferguson et al. BMC Medical Education (2016) 16:9 DOI 10.1186/s12909-015-0504-1 RESEARCH ARTICLE Open Access Education and practice gaps on atrial fibrillation and anticoagulation: a survey of cardiovascular