Adherence in patients with atrial fibrillation treated with dabigatran

Grześk, Grzegorz; Janiszewska, Ewa; Malinowski, Bartosz; Kubica, Aldona; Wiciński, Michał

doi:10.5603/kp.a2018.0194

Cited by 14 publications

(18 citation statements)

References 8 publications

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“…Recent study in patients with atrial fibrillation in Poland found a high rate of nonadherence for dabigatran. 30 Interestingly, in our study, we observed the highest rate of primary nonadherence in the case of dabigatran.…”

Section: Article Informationmentioning

confidence: 40%

Primary non-adherence to medication and its drivers of in Poland: findings of the analysis of the e-prescription pilot

Kardas

Cieszyński

Czech³

et al. 2019

Polish Archives of Internal Medicine

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IntroductIon Primary nonadherence to medication occurs when a patient does not fill a prescription and often leads to suboptimal patient outcomes, lost productivity, and increased net costs. Pilot introduction of electronic prescriptions (e-prescriptions) in Poland took place in 2018, enabling nationwide assessment of primary nonadherence. objEctIvEs To determine the prevalence and drivers of primary nonadherence in Poland. MEthods This retrospective analysis included data from all e-prescriptions issued in Poland in 2018. Primary nonadherence was defined as not filling a prescription within 1 month from the date of issuing. rEsuLts Out of all 119 880 e-prescriptions issued in Poland in 2018, 94 913 were filled, thus the primary nonadherence rate reached 20.8%. Although no differences in primary nonadherence were observed between sexes, age was found to have a significant effect, with older groups showing lower rates of primary nonadherence. In addition, slightly lower rates of primary nonadherence (17.0%) were found for e-prescriptions issued for selected drugs of key importance (n = 47 492). Multivariable analysis performed within this subset showed that those aged ≥75 years had the lowest odds for nonadherence (odds ratio, 0.55; 95% CI, 0.48-0.64). Differences in primary nonadherence rates were observed across therapeutic areas (lowest value in antibiotics, 14.3%), drug classes (lowest value in sulfonylureas, 13.2%), and individual drugs. Primary nonadherence rates were lower for drugs covered by the "Leki 75+" program, which makes them free of charge for those aged 75 years or older. concLusIons A high percentage of prescriptions issued in Poland are never filled. E-prescriptions allow the identification and analysis of drivers of this phenomenon. Our findings may help designing national health and medicine policies.

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Section: Article Informationmentioning

confidence: 40%

Primary non-adherence to medication and its drivers of in Poland: findings of the analysis of the e-prescription pilot

Kardas

Cieszyński

Czech³

et al. 2019

Polish Archives of Internal Medicine

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“…Smoking cigarettes also has a significant negative influence on the level of vitamin D [11]. Beyond modifiable factors there are dimensions such as genetic determinants, individual variations [12] or age that are not modifiable [13]. The relationship between gender and vitamin D deficiency or 25(OH)D level is inconsistent and elaborate in non-athletes.…”

Section: Introductionmentioning

confidence: 99%

Impact of Vitamin D on Physical Efficiency and Exercise Performance—A Review

Wiciński

Adamkiewicz

et al. 2019

Nutrients

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Vitamin D deficiency amongst athletes and the general population seems to be a prominent problem. The most recognized role of vitamin D is its regulation of calcium homeostasis; there is a strong relationship between vitamin D and bone health. Moreover, its concentrations are associated with muscle function and immune response in both the general and athletic populations. Vitamin D level is strongly connected with the presence of VDRs (vitamin D receptors) in most human extraskeletal cells. Expression of multiple myogenic transcription factors enhancing muscle cell proliferation and differentiation is caused by an exposure of skeletal muscles to vitamin D. The aim of this review is to summarize current understanding of the significance of vitamin D on exercise performance and physical efficiency, as well to analyze the impact of vitamin D on multiple potential mechanisms. More high-quality research studies, considering free 25(OH)D as a better marker of vitamin D status, the baseline level of 25(OH)D and multiple pathways of vitamin D acting and usage in athletes are required.

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“…In the study by Konieczyńska et al, performed on a smaller patient group, gingival bleeding was more frequent in the apixaban group, suggesting that this agent was preferentially used in patients with elevated bleeding risk. NOAC treatment is associated with lower rates of minor bleeding than VKAs, which may explain better adherence to NOACs and may provide a reason why these patients should be switched to NOACs . Minor bleeding was more frequently recorded on reduced doses of NOACs.…”

Section: Discussionmentioning

confidence: 98%

“…A retrospective analysis by Yao et al showed that during a median of 1.1‐year follow‐up, less than half of patients treated with NOACs and VKAs adhered to treatment. Grześk et al reported that only 50% of patients had an optimal therapeutic concentration of dabigatran. The need to improve adherence in anticoagulant therapy should be stressed because adherence was shown to correlate with therapy duration and frequency of minor bleeding.…”

Section: Discussionmentioning

confidence: 99%

Minor bleeding affects the level of knowledge in patients with atrial fibrillation on oral anticoagulant therapy

et al. 2020

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Despite advances in treatment, atrial fibrillation (AF) remains the cause of about 15% to 20% of all strokes and 36% of strokes in individuals older than 80 years, which results in high morbidity and mortality worldwide. 1,2 Large randomised trials demonstrated that anticoagulant therapy in AF patients reduces the relative risk of stroke approximately by 65%, 3 but it also increases the risk of bleeding. Major bleeding in AF patients was reported in the range 2%-3.6% of subjects treated with non-vitamin K antagonist oral anticoagulants (NOACs) and about 3% in those on warfarin in seminal NOAC trials. [4][5][6] The various studies showed that minor bleeding is also a frequent adverse event both with VKA and NOAC (depending on the definition of minor bleeding). 7-9 Abstract Background: Anticoagulant therapy in patients with atrial fibrillation (AF) increases the risk of minor bleeding, which is mostly accepted by patients. We aimed to assess whether continuation of anticoagulation despite minor bleeding is associated with a higher level of knowledge on AF and anticoagulation. Methods and results:In 1525 patients with AF on oral anticoagulation who completed the Jessa AF Knowledge Questionnaire (JAKQ) (median age: 72 years [range, 65-79 years]; men: 54.6%), persistent self-reported minor bleeding was recorded.Minor bleeding was observed in 567 patients (37.2%) including 224 patients (39.5%) on vitamin K antagonists (VKAs) and 343 (60.5%) on non-vitamin K antagonist oral anticoagulants (NOACs). The risk of minor bleeding was lower among patients on NOACs than on VKAs (33.5% vs 44.6%; P < .0001). Multiple logistic regression showed that minor bleeding was associated with the use of NOACs (odds ratio [OR] 0.75; 95% CI 0.59-0.97), female gender (OR 2.19; 95% CI, 1.74-2.75; P < .0001), history of major bleeding (OR 2.85; 95% CI, 1.96-4.14; P < .0001), time since AF diagnosis (OR 1.04; 95% CI, 1.01-1.06; P < .0001), concomitant vascular disease (OR 1.43; 95% CI, 1.10-1.87; P = .0008) and diabetes mellitus (OR 1.3; 95% CI, 1.02-1.65, P = .03).Patients with minor bleeding, compared with the remaining subjects scored higher on the JAKQ (median, 62.5% vs 56.2%, respectively, P < .0001). The former group knew more about the purpose of anticoagulant therapy (71.8% vs 65.7%, P = .01) and bleeding as its key side effect (66.1% vs 52.7%, P < .0001), and were better informed on the safest painkillers to use in combination with anticoagulation (48% vs 35%, P < .0001). Conclusion:This study suggests that AF patients who accept persistent minor bleeding have better knowledge on the disease and anticoagulation therapy compared with those free of these side effects.

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Adherence in patients with atrial fibrillation treated with dabigatran

Cited by 14 publications

References 8 publications

Primary non-adherence to medication and its drivers of in Poland: findings of the analysis of the e-prescription pilot

Primary non-adherence to medication and its drivers of in Poland: findings of the analysis of the e-prescription pilot

Impact of Vitamin D on Physical Efficiency and Exercise Performance—A Review

Minor bleeding affects the level of knowledge in patients with atrial fibrillation on oral anticoagulant therapy

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