Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study

Abstract

background Despite simpler regimens than vitamin K antagonists (VKas) for stroke prevention in atrial fibrillation (aF), adherence (taking drugs as prescribed) and persistence (continuation of drugs) to direct oral anticoagulants are suboptimal, yet understudied in electronic health records (ehrs). Objective We investigated (1) time trends at individual and system levels, and (2) the risk factors for and associations between adherence and persistence. Methods in UK primary care ehr (The health information network 2011-2016), we investigated adherence and persistence at 1 year for oral anticoagulants (Oacs) in adults with incident aF. Baseline characteristics were analysed by Oac and adherence/persistence status. risk factors for nonadherence and non-persistence were assessed using cox and logistic regression. Patterns of adherence and persistence were analysed. results among 36 652 individuals with incident aF, cardiovascular comorbidities (median cha 2 Ds 2 Vasc[congestive heart failure, hypertension, age≥75 years, Diabetes mellitus, stroke, Vascular disease, age 65-74 years, sex category] 3) and polypharmacy (median number of drugs 6) were common. adherence was 55.2% (95% ci 54.6 to 55.7), 51.2% (95% ci 50.6 to 51.8), 66.5% (95% ci 63.7 to 69.2), 63.1% (95% ci 61.8 to 64.4) and 64.7% (95% ci 63.2 to 66.1) for all Oacs, VKa, dabigatran, rivaroxaban and apixaban.One-year persistence was 65.9% (95% ci 65.4 to 66.5), 63.4% (95% ci 62.8 to 64.0), 61.4% (95% ci 58.3 to 64.2), 72.3% (95% ci 70.9 to 73.7) and 78.7% (95% ci 77.1 to 80.1) for all Oacs, VKa, dabigatran, rivaroxaban and apixaban. risk of non-adherence and non-persistence increased over time at individual and system levels. increasing comorbidity was associated with reduced risk of non-adherence and non-persistence across all Oacs. Overall rates of 'primary non-adherence' (stopping after first prescription), 'non-adherent nonpersistence' and 'persistent adherence' were 3.5%, 26.5% and 40.2%, differing across Oacs. Conclusions adherence and persistence to Oacs are low at 1 year with heterogeneity across drugs and over time at individual and system levels. Better understanding of contributory factors will inform interventions to improve adherence and persistence across Oacs in individuals and populations.on July 10, 2020 by guest. Protected by copyright.

Satisfaction of Patients with Nonvitamin K Anticoagulants Compared to Vitamin K Antagonists: a Systematic Review and Meta-analysis

“…3,5,13 A recent study that assessed 12-month adherence and persistence with OACs reported adherence rates of 63.1 to 66.5% with NOACs, compared with 55.2% with VKAs, and persistence with NOACs of 61.4 to 78.7%, compared with 65.9% with VKAs. 4 Moreover, it demonstrated heterogeneity among different NOACs, possibility due to different regimens. These findings showed mostly higher values with NOACs compared with VKAs, but they are far from the desired, suggesting that treatment satisfaction is not the only factor to take into account.…”

“…1 However, maintaining treatment adherence (taking medication as prescribed) and persistence (continuation of treatment for the prescribed duration) in the long term can be challenging. 1,4 Due to numerous drug and food interactions and genetically determined interindividual differences, treatment with VKAs requires frequent analytical monitoring of international normalized ratio (INR) with dose adjustment. 1 Moreover, VKAs may require changes in lifestyle, dietary restrictions, and limitations of autonomy and therefore affect patients' quality of life.…”

Epidemiology and treatment of atrial fibrillation in patients with type 2 diabetes in the UK, 2001–2016

“…THIN is a UK primary care database containing anonymized, clinical and prescribing data with more than 15 million cumulative patients, covering approximately 6.0% of the UK population 9 . THIN database is widely used healthcare database for the population-based medical research and has previously been used to study prescribing of OAC medications 10 – 14 .…”

Switching warfarin patients to a direct oral anticoagulant during the Coronavirus Disease-19 pandemic

“…Long-term adherence to DOAC therapy has been reported to be sub-optimal; with a reported 65.9% adherence at one year [ 7 ] Patients' adherence beliefs are affected by numerous factors, which in part may be influenced by the clinician-patient interaction. Outside of a pandemic setting, our own group have reported on short term changes in beliefs (medication: overuse, harm, necessity and concerns) and quality of life in 142 poorly controlled patients, switched from warfarin to a DOAC [ 8 ].…”