Patient-reported health utility of stroke and gastrointestinal bleeding related to DOACs in atrial fibrillation: a vignette-based substudy of a randomized controlled trial

Direct oral anticoagulants (DOACs) are widely used in patients with atrial fibrillation (AF) to prevent stroke but increase the risk of upper gastrointestinal bleeding (UGIB). We aimed to quantify patient-perceived health-related quality-of-life (HRQoL) decrements associated with DOAC-related clinical events—stroke and UGIB—using a vignette-based approach. A survey was conducted with 391 AF patients on DOACs, embedded within a randomized trial evaluating proton pump inhibitor (PPI) co-therapy. Participants evaluated four hypothetical health states (stroke, post-stroke, UGIB, and post-UGIB) using EQ-5D-5L. The mean EQ-5D index for current health was 0.90 (SD 0.11). When imagining stroke, 89–95% of respondents perceived worsened HRQoL, particularly in self-care and usual activity domains. In contrast, 44–61% perceived worsened health in UGIB scenarios, primarily related to anxiety and depression. The estimated decrement in EQ-5D utility score was − 0.49 (SE 0.01) for stroke and − 0.16 (SE 0.01) for UGIB. Stroke was perceived to have a greater impact on the overall HRQoL domain, whereas UGIB was perceived to affect emotional well-being (anxiety/depression) disproportionately. These vignette-derived perceived utilities may inform patient-centered discussions and provide inputs for decision-analytic and cost-utility models evaluating anticoagulation strategies.Trial registration number: KCT0006848.