TREATS-AF:Educational intervention vs usual care on anticoagulation therapy control based on a SAMe-TT2R2 score-guided strategy
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Description
Anticoagulants ('blood thinners') are needed to prevent stroke and death in patients with atrial fibrillation (AF). AF is the world's most common form of irregular heartbeat, including in Thailand. Anticoagulation is a mainstay treatment in AF patients to prevent strokes occurring. Warfarin is the most commonly used anticoagulant in Thailand, but because it is influenced by many diet and patient factors it can be difficult to achieve good anticoagulation control. In Thailand, because of this, most patients receive inadequate control of their anticoagulation when using warfarin, leading to increased risk of stroke and death. Our aim is to conduct a randomised-controlled trial (RCT) in Thai AF patients who have not used an anticoagulant before to evaluate the use of a simple clinical prediction score (SAMe-TT2R2) to help identify those patients likely to have a good response to anticoagulation with warfarin, compared with usual care. Predicted poorer responders (SAMe-TT2R2 >2) will be given an educational-behavioural intervention based on our previous RCT (TREAT trial) as an addition to routine care to improve their TTR on warfarin. In this project, we will first undertake cultural adaptation of the TREAT intervention and translation, translation and validation of the patient knowledge questionnaire to ensure applicability to Thailand, and will include a qualitative study exploring patient satisfaction and acceptance of the TREAT approach and assess the impact on healthcare costs of this strategy. In addition, we would assess cost-effectiveness of the intervention in the Thailand healthcare system, and also explore composite clinical outcomes related to the intervention. This study, if successful, will provide an inexpensive, easy approach that can be readily integrated into the existing Thai health service to improve the health of those patients with AF reducing both their risk of stroke and associated death. It will also give us an understanding of patients' perceptions of the treatment which we may be able to use to improve our approach. This collaborative study will also facilitate further research between the UK and Thailand and development of new patient-centred tools (e.g. Thai-version of TREAT educational intervention, Thai-language questionnaires, etc.).
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The Newton Fund builds research and innovation partnerships with developing countries across the world to promote the economic development and social welfare of the partner countries.
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