Educational-behavioural intervention for warfarin in atrial fibrillation patients: TREAT study


Effective stroke prevention for atrial fibrillation patients requires anticoagulation either with a vitamin K antagonist, such as warfarin, or one of the new oral anticoagulants. Efficacy of warfarin requires maintenance of a narrow therapeutic target, which is often poorly controlled in practice due in part to a lack of understanding about treatment.

The team developed an intensive-educational intervention for AF patients. The intervention consists of a one-off group session and a DVD featuring patient interview clips discussing concerns about AF and oral anticoagulants. Compared to usual care the intervention led to significant improvements in patients’ understanding of the necessity of warfarin and reduced their perception of treatment harm.


Atrial fibrillation (AF) is the leading cause of stroke. Evidence supports the use of oral anticoagulation for stroke prevention. In the UK, until 2012, this meant Warfarin, which requires patients to maintain a narrow therapeutic range (TTR), ideally for more than 70 per cent of the time. However, they often fail to maintain adequate time within TTR, reducing treatment efficacy. Research suggests that improving patients’ knowledge of AF and warfarin may help improve TTR.

Patients’ lack of knowledge presents a barrier to uptake and adherence. Their inaccurate perceptions may lead to non-adherence to medication. The team therefore wanted to develop an intervention which would improve warfarin control and patient knowledge about AF and OAC, aiding long-term adherence in AF patients.


The TREAT study had two main objectives. Firstly, it aimed to develop a behavioural-educational intervention, in collaboration with patients, healthcare professionals, and patient organisations, for AF patients who were initiating warfarin for stroke prevention. Secondly, it hoped that the behavioural-educational intervention is effective in improving patients’ anticoagulation control (time in therapeutic range, or TTR) compared with usual care.

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QiC Anticoagulation Commended 2014
Anticoagulation Innovation of the Year
Educational-behavioural intervention for warfarin in atrial fibrillation patients: TREAT study
by City Hospital, University of Birmingham and Aston University


Deirdre Lane

Job title:
Senior lecturer in cardiovascular health
Place of work:
University of Birmingham Centre for Cardiovascular Sciences, City Hospital
0121 5075080