Adherence and persistence to oral anticoagulants in patients with atrial fibrillation: A Belgian nationwide cohort study

Abstract

BackgroundSince non-vitamin K antagonist oral anticoagulants (NOACs) do not require coagulation monitoring, concerns of lower adherence and persistence to NOACs than vitamin K antagonists (VKAs) have been raised. Moreover, little is known on the frequency of permanent cessation and switching between anticoagulants in patients with atrial fibrillation (AF). Therefore, persistence, reinitiation, switching and adherence to oral anticoagulants (OACs) were investigated.Materials and methodsAF patients with a first OAC prescription claim between 2013 and 2019 were identified in Belgian nationwide data. Persistence, reinitiation and switching were estimated using Kaplan-Meier analyses. Adherence was investigated using the proportion of days covered (PDC). Predictors for non-adherence and non-persistence were identified by multivariable logistic regression.ResultsAmong 277,782 AF patients, 69.6% NOAC and 37.2% VKA users were persistent after 1 year, whereas 44.3% and 18.9% after 5 years, respectively. After one year, 67.1% rivaroxaban, 68.1% dabigatran, 69.8% apixaban, and 76.9% edoxaban users were persistent. Among subjects having discontinued NOAC or VKA treatment, 75.4% and 46.1% reinitiated any OAC within 5 years, respectively. VKAs were more frequently switched to NOACs than vice versa (17.6% versus 2.5% after 1 year). After 1 year, a high PDC (≥ 90%) was observed in 87.8% apixaban, 88.6% dabigatran, 91.3% rivaroxaban, and 94.7% edoxaban users (90.2% NOAC users). Adherence and persistence were higher in older, female subjects, while lower in subjects with dementia or hyperpolypharmacy.ConclusionAdherence and persistence to NOACs were high. However, 10% of subjects were non-adherent after 1 year and one-fourth did not reinitiate anticoagulation within 5 years after NOAC discontinuation.

Long-term comparative effectiveness and safety of dabigatran, rivaroxaban, apixaban and edoxaban in patients with atrial fibrillation: A nationwide cohort study

“…Data were provided by two nationwide databases, the InterMutualistic Agency (IMA) database and Minimal Hospital Dataset (MHD), as described before ( Grymonprez et al, 2022 ). The IMA centralizes all claims data from Belgian health insurance funds on reimbursed ambulatory and hospital care, including demographic characteristics (age, sex, date of death), medical procedures (diagnostic or therapeutic procedures and other reimbursed care) and drug prescription claims ( Grymonprez et al, 2022 ; IMA/AIM, 2021 ). As health insurance is legally mandatory in Belgium, the source population represents all legal residents with reimbursed medication or care.…”

“…As health insurance is legally mandatory in Belgium, the source population represents all legal residents with reimbursed medication or care. The MHD aggregates hospital discharge diagnoses of every hospital admission in Belgium, coded in International Classification of Diseases (ICD) codes (ICD-9 up to 2014, ICD-10 from 2015 onwards) ( MZG, 2021 ; Grymonprez et al, 2022 ). This study was approved by the IMA and MHD database administrators as well as by the ‘Sectoral Committee of Social Security and Health, Section Health’, a subcommittee of the Belgian Commission for the Protection of Privacy (approval code IVC/KSZG/20/344) ( eHealth-platform, 2021 ).…”

“…Data were provided by two nationwide databases, the InterMutualistic Agency (IMA) database and Minimal Hospital Dataset (MHD), as described before (Grymonprez et al, 2022).…”

“…The IMA centralizes all claims data from Belgian health insurance funds on reimbursed ambulatory and hospital care, including demographic characteristics (age, sex, date of death), medical procedures (diagnostic or therapeutic procedures and other reimbursed care) and drug prescription claims (Grymonprez et al, 2022;IMA/AIM, 2021). As health insurance is legally mandatory in Belgium, the source population represents all legal residents with reimbursed medication or care.…”

Trends in oral anticoagulant use in patients with atrial fibrillation in Belgium from 2013 to 2019: A nationwide cohort study

“…The MHD, collected by the Belgian Ministry of Health, aggregates hospital discharge diagnoses of every admission in Belgian hospitals (including hospitalizations, daycare stays and emergency room contacts), coded in International Classification of Diseases (ICD) codes (ICD-9 up to 2014, ICD-10 from 2015 onwards). 13,15,16 All single cases of the study population could be identified in both databases. The trusted third party 'eHealth' was responsible for deterministically linking both databases using the national social security number as unique patient identifier.…”