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Atrial Fibrillation on Apixaban TreatmentNCT06869083

Application-Delivered Patient Education in Enhancing the Usage of Apixaban in Patients With Atrial Fibrillation

A study testing AF application enhancing AF education and drug adhrence and AF application without enhancing AF education and drug adhrence in people with Atrial Fibrillation on Apixaban Treatment, run by Yonsei University at 1 site in South Korea.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

"AF is the most common arrhythmia, with an overall prevalence of approximately 2%. It is particularly prevalent in individuals over 60 years old, affecting about 5% of this population. With the aging population, the global prevalence of AF is increasing. Read more about this study

Who is it for?
Ages 19 to 90 years
What is being tested?
AF application enhancing AF education and drug adhrence and AF application without enhancing AF education and drug adhrence
Could I receive a placebo?
No, everyone receives an active treatment
How many people
5,200 participants
Where
1 siteSouth Korea
Study dates
Mar 2025to 31 Jul 2030
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 19 to 90 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Adults aged 19 years or older with non-valvular atrial fibrillation (NVAF).
  • Willingness to provide informed consent and participate in the study.
  • Receiving Elxaban as anticoagulation therapy.
  • Ability to use the mobile application.

Who cannot join

  • Inability to understand the study or refusal to provide consent.
  • Minors under 19 years of age.
  • Pregnant or breastfeeding women.
  • Conditions requiring chronic anticoagulation therapy other than atrial fibrillation (e.g., mechanical heart valve replacement).
  • Life expectancy of less than one year due to severe comorbid conditions.
  • Contraindications to Elxaban use, including:
Show all 19Show fewer
  • Hypersensitivity to the active ingredient or any excipients of the drug.
  • Severe renal impairment (CrCL <15 mL/min).
  • Clinically significant active bleeding.
  • Increased bleeding risk due to the following conditions:
  • Recent history of gastrointestinal ulcer.
  • High-risk malignant neoplasms.
  • Recent brain or spinal cord injury.
  • Recent history of brain, spinal, or ophthalmic surgery.
  • Recent history of intracranial or cerebral hemorrhage.
  • Suspected or confirmed esophageal varices.
  • Arteriovenous malformations.
  • Vascular aneurysms.
  • Spinal or intracranial vascular abnormalities.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

South Korea1 site
  • Division of Cardiology Severance Cardiovascular Hospital, Yonsei University College of Medicine

    Seoul, 03722

Other trials in South Korea

About this study

Official title: Application-Delivered Patient Education in Enhancing the Usage of Apixaban in Patients With Atrial Fibrillation: Randomized Control Therapy

"AF is the most common arrhythmia, with an overall prevalence of approximately 2%. It is particularly prevalent in individuals over 60 years old, affecting about 5% of this population. With the aging population, the global prevalence of AF is increasing. In South Korea, the overall prevalence of AF increased from 0.73% in 2006 to 1.53% in 2015, a 2.1-fold increase. By 2060, it is projected that 2.3 million people in Korea will have AF, with a prevalence rate of 5.81%. AF accounts for approximately 20% of all ischemic strokes, and patients with AF have an annual risk of ischemic stroke ranging from 6% to 10%. Additionally, AF can lead to heart failure and doubles the mortality rate. Despite various treatment options, the mortality rate associated with AF continues to rise annually.

Anticoagulation therapy for the prevention of thromboembolism in AF is a crucial treatment approach. Traditional warfarin therapy has been shown to reduce the risk of stroke by approximately 63%. Recently developed non-vitamin K oral anticoagulants (NOACs) have demonstrated similar efficacy to warfarin while offering a lower risk of hemorrhagic complications, particularly intracranial hemorrhage, making them a safer alternative.

Read more

Adherence to anticoagulant therapy is crucial for the effective prevention of stroke in patients with AF. Poor adherence to anticoagulants significantly increases the risk of thromboembolic events, including ischemic stroke. Studies have shown that patients with low adherence to anticoagulation therapy experience higher rates of stroke and mortality compared to those who consistently take their medication as prescribed. Ensuring proper adherence to anticoagulants, whether traditional warfarin or newer non-vitamin K oral anticoagulants (NOACs), is essential to maximizing treatment benefits while minimizing complications. Factors influencing adherence include medication side effects, complexity of the treatment regimen, patient awareness, and regular follow-up with healthcare providers. Strategies to improve adherence, such as patient education, simplified dosing regimens, and routine monitoring, play a key role in reducing the burden of AF-related strokes.

The burden of cardiovascular risk factors, including lifestyle factors and borderline conditions, as well as comorbidities, significantly influences both the risk of AF development and its prognosis. The continuum of unhealthy lifestyle habits, risk factors, and cardiovascular diseases contributes to atrial remodeling, cardiomyopathy, and ultimately, the onset of AF through the combined effects of multiple interacting factors. One of the three core components of the Atrial Fibrillation Better Care (ABC) pathway for comprehensive AF management is the ""C"" component, which focuses on the identification and management of comorbidities, cardiometabolic risk factors, and unhealthy lifestyle habits. Effective management of these risk factors and cardiovascular diseases plays a crucial role in stroke prevention and in reducing AF burden and symptom severity. Recent randomized clinical trials have shown that targeted treatment of underlying conditions improves the maintenance of sinus rhythm following AF ablation in patients with persistent AF and heart failure.

Education by healthcare providers regarding medication adherence and risk factor management for existing AF patients is often limited due to constraints in manpower and resources. However, leveraging new technologies such as mobile applications can help overcome these limitations by enhancing patient education and improving medication adherence without the need for additional healthcare personnel.

This study is fundamentally a prospective, multicenter, randomized, open-label clinical trial. Patients with atrial fibrillation who are prescribed edoxaban at participating institutions will be randomly assigned to either an app-based anticoagulation education group or a non-education group. Primary objective is to demonstrate that an app-based education program for patients with AF taking apixaban results in a lower incidence of major cardiovascular events (ischemic stroke/systemic embolism, major bleeding, hospitalization, myocardial infarction, and death) compared to the non-education group. Secondary Objective is to investigate the impact of the intervention on secondary events, including stroke, systemic embolism, transient ischemic attack (TIA), major bleeding, non-major bleeding, hospitalization, myocardial infarction, death, and medication adherence. Exploratory Objective are to assess treatment satisfaction using the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire, and to evaluate cognitive function changes using the Korean Dementia Screening Questionnaire (KDSQ).

Read the detailed description

"This study is fundamentally a prospective, multicenter, randomized, open-label clinical trial. Patients with AF receiving apixaban at participating institutions will be randomly assigned to either an app-based anticoagulation education group or a non-education group. The incidence rates of primary, secondary, and exploratory events will be assessed.

The app will include content related to anticoagulation therapy, such as: medication reminders or intake confirmation for anticoagulants, the importance of anticoagulation therapy in stroke prevention, the role of antiarrhythmic and rate-control medications in symptom management, the necessity of controlling risk factors such as hypertension, diabetes, and hyperlipidemia, and quality of life and cognitive function assessments through questionnaires.

Follow-up assessments will be conducted every six months after enrollment. The anticipated enrollment period is four years, with a minimum follow-up duration of one year.

Participants will have voluntary access to educational materials in the app. Medication adherence will be encouraged through reminder alarms, while other educational components will not have specific evaluation methods. The study investigator is responsible for developing the medication adherence education app. The app's content is currently being finalized, and development will be completed using research funding after study approval.

Randomization will be conducted using an Excel macro function, assigning participants in a 1:1 ratio. The randomization process will be uploaded to iCReaT, an electronic case report form (eCRF) system, allowing verification at the time of participant registration.

Primary Outcome: The primary composite outcome consists of ischemic stroke, intracranial hemorrhage, and myocardial infarction. This outcome was selected based on previous domestic studies demonstrating that medication adherence reduces the incidence of these composite events. Evaluations will be conducted every six months after enrollment. The anticipated enrollment period is four years, with a minimum follow-up duration of one year.

Secondary Outcomes: The study will assess the following secondary outcomes: Stroke (ischemic and hemorrhagic), Transient ischemic attack (TIA), Systemic embolism, Major bleeding, Non-major bleeding, Myocardial infarction, Death, Hospitalization events, and Medication adherence. Evaluations will be conducted every six months after enrollment. The anticipated enrollment period is four years, with a minimum follow-up duration of one year.

"

Being tested
AF application enhancing AF education and drug adhrence, AF application without enhancing AF education and drug adhrence
Keywords
atrial fibrillation, apixaban, anticoagulation, adherence, application, eduction
Medical subject headings
Atrial Fibrillation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • AF application enhancing AF education and drug adhrenceOther

    This group will use AF-application. The app will include content related to anticoagulation therapy, such as: medication reminders or intake confirmation for anticoagulants, the importance of anticoagulation therapy in stroke prevention, the role of antiarrhythmic and rate-control medications in symptom management, the necessity of controlling risk factors such as hypertension, diabetes, and hyperlipidemia, and quality of life and cognitive function assessments through questionnaires.

  • AF application without enhancing AF education and drug adhrenceOther

    This group will use AF-application. However, this application will not contain materials enhancing AF education and adherence.

Study groups in NCT06869083
Study groupRoleWhat they receive
App education groupExperimentalNot described
Receives: Other: AF application enhancing AF education and drug adhrence
No-App education groupActive comparatorNot described
Receives: Other: AF application without enhancing AF education and drug adhrence

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The primary composite outcome

    The primary composite outcome consists of ischemic stroke, intracranial hemorrhage, and myocardial infarction.

    Measured: every 6 month up to 4 years until the end of study, with a minum follow-up duration of one year.

Secondary outcomes (18)
  1. Secondary end points assessed time to stroke (ischemic and hemorrhagic)

    Measured: every 6 month up to 4 years until the end of study

  2. transient ischemic attack (TIA)

    Measured: every 6 month up to 4 years until the end of study

  3. systemic embolism

    Measured: every 6 month up to 4 years until the end of study

  4. major bleeding

    Major bleeding was defined according to the criteria of International Society on Thrombosis and Haemostasis (ISTH).

    Measured: every 6 month up to 4 years until the end of study

  5. clinically relevant non-major bleeding

    Clinically relevant non-major bleeding define a bleeding event that is neither a major bleed as defined by the ISTH 1 nor a non-clinically consequential minor bleeding event.

    Measured: every 6 month up to 4 years until the end of study

  6. myocardial infarction

    Measured: every 6 month up to 4 years until the end of study

  7. death

    Measured: every 6 month up to 4 years until the end of study

  8. hospitalization events

    Measured: every 6 month up to 4 years until the end of study

  9. medication adherence

    Medication adherence is defined as the percentage of the prescribed doses of the medication actually taken by the patient over a follow-up duration.

    Measured: every 6 month up to 4 years until the end of study

  10. Secondary end points assessed time to stroke (ischemic and hemorrhagic)

    Measured: a minum follow-up duration of one year.

  11. transient ischemic attack (TIA)

    Measured: a minum follow-up duration of one year.

  12. systemic embolism

    Measured: a minum follow-up duration of one year.

  13. major bleeding

    Major bleeding was defined according to the criteria of International Society on Thrombosis and Haemostasis (ISTH).

    Measured: a minum follow-up duration of one year.

  14. clinically relevant non-major bleeding

    Clinically relevant non-major bleeding define a bleeding event that is neither a major bleed as defined by the ISTH 1 nor a non-clinically consequential minor bleeding event.

    Measured: a minum follow-up duration of one year.

  15. myocardial infarction

    Measured: a minum follow-up duration of one year.

  16. death

    Measured: a minum follow-up duration of one year.

  17. hospitalization events

    Measured: a minum follow-up duration of one year.

  18. medication adherence

    Medication adherence is defined as the percentage of the prescribed doses of the medication actually taken by the patient over a follow-up duration.

    Measured: a minum follow-up duration of one year.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted11 Mar 2025
  2. Study startMar 2025 (estimated)
  3. Primary completion28 Feb 2030 (estimated)
  4. Study completion31 Jul 2030 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Supportive care
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
5,200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06869083
Sponsor's protocol ID
4-2024-1210
Status last verified
Mar 2025
First submitted
20 Feb 2025
Last updated
11 Mar 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A study testing AF application enhancing AF education and drug adhrence and AF application without enhancing AF education and drug adhrence in people with Atrial Fibrillation on Apixaban Treatment, run by Yonsei University at 1 site in South Korea.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 19 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 11 Mar 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in South Korea. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The primary composite outcome (time frame: every 6 month up to 4 years until the end of study, with a minum follow-up duration of one year.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 11 Mar 2025.

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