Dabigatran Persistence and Outcomes Following Discontinuation in Atrial Fibrillation Patients from the GLORIA-AF Registry

Paquette, Miney; França, Lionel Riou; Teutsch, Christine; Diener, Hans‐Christoph; Lu, Shihai; Dubner, Sérgio; Sheng, Chang; Rothman, Kenneth J.; Zint, Kristina; Halperin, Jonathan L.; Olshansky, Brian; Huisman, Menno V.; Lip, Gregory Y. H.; Nieuwlaat, Robby

doi:10.1016/j.amjcard.2019.10.047

Cited by 22 publications

(38 citation statements)

References 26 publications

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“…Thus, patients may not be seen by their cardiologist for longer intervals or until an outcome event or other complication arises. 65 Supporting this hypothesis is the higher persistence reported with a NOAC in AF patients followed by GPs compared with specialists 41 which has similarly been reported for other patient groups such as those taking bone sparing drugs. 66 There may be opportunities to improve persistence through encouragement of certain patient management practices such as cardiologist referral to GPs for follow-up after initial diagnosis is made, as one example.…”

Section: Other External Factorsmentioning

confidence: 69%

“…change in persistence) to rates of clinically important outcomes such as stroke or mortality, and studies that report outcomes following discontinuation meet the first important step to establish if there is a relationship at all. 19 , 41 , 42 …”

Section: Study Factorsmentioning

confidence: 99%

“…Following patients from the time of treatment initiation can also help characterize when patients may be most likely to discontinue, an aspect of high importance when considering how to maximize the impact of interventions (especially those that come with high cost and/or resource burden) to optimize persistence. 30 , 41 …”

Section: Study Factorsmentioning

confidence: 99%

“…In addition to considering the broad selection of patients included in studies of persistence, there are additional patient-level clinical characteristics that have been associated with OAC persistence which should be acknowledged, such as lower persistence reported in younger males, 6 those with higher bleeding risk 50 and lower stroke risk, 30 , 35 , 40 and higher persistence in patients with higher body mass index. 41 Other co-morbidities such as diabetes have been reported to be associated with a reduced risk for non-adherence, while hypertension and vascular disease was associated with a higher risk for non-adherence. 19 In contrast, certain AF characteristics which may be surrogate markers for disease severity such as asymptomatic or minimally symptomatic AF and permanent AF 30 have been associated with higher persistence.…”

Section: Patient and Treatment Factorsmentioning

confidence: 99%

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Methodological considerations for investigating oral anticoagulation persistence in atrial fibrillation

Paquette

Mbuagbaw

Iorio

et al. 2020

European Heart Journal - Cardiovascular Pharmacotherapy

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Aims Reports of long-term oral anticoagulant (OAC) therapy for atrial fibrillation (AF) reveal highly variable, and generally suboptimal estimates of medication persistence. The objective of this review is to summarize current literature and highlight important methodological considerations for interpreting persistence research and designing studies of persistence on OAC treatment. Methods and Results We summarize differences in study methodology, setting, timing, treatment and other factors associated with reports of better or worse persistence. For example, prospective compared to retrospective study designs are associated with higher reported persistence. Similarly, patient factors such as permanent AF or high stroke risk, and treatment with non-vitamin K oral antagonists relative to vitamin K antagonists are associated with higher persistence. Persistence has also been reported to be higher in Europe compared to North America and higher when the treating physician is a general practitioner compared to a specialist. We propose a framework for assessing and designing persistence studies. This framework includes aspects of patient selection, reliability and validity of measures, persistence definitions, clinical utility of measurements, follow-up periods and analytic approaches. Conclusions Differences in study design, patient selection, treatments and factors such as the countries/regions where studies are conducted or the type of treating physician may help explain the variability in OAC persistence estimates. A framework is proposed to assess persistence studies. This may have utility to compare and interpret published studies as well as for planning of future studies.

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Section: Other External Factorsmentioning

confidence: 69%

Section: Study Factorsmentioning

confidence: 99%

Section: Study Factorsmentioning

confidence: 99%

Section: Patient and Treatment Factorsmentioning

confidence: 99%

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Methodological considerations for investigating oral anticoagulation persistence in atrial fibrillation

Paquette

Mbuagbaw

Iorio

et al. 2020

European Heart Journal - Cardiovascular Pharmacotherapy

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“…и ~70%, соответственно [17]. Недавно опубликованы глобальные результаты изучения удержания пациентов на терапии дабигатраном, причин прекращения приема и исходов после прекращения терапии [20]. В целом двухлетняя вероятность удержания на терапии дабигатраном во II фазе регистра GLORIA-AF составила 70,9% (95% ДИ 69,6-72,2 9]).…”

Section: характеристика пациентов в группах с различными дозами дабигunclassified

Clinical performance of the atrial fibrillation in the Russian population depending on the antithrombotic therapy: findings from the GLORIA-AF registry phase 2

Шляхто¹,

Villevalde²,

Ezhov³

et al. 2020

Russ J Cardiol

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Aim. To analyze clinical characteristics of patients with nonvalvular atrial fibrillation (AF) in the Russian population, enrolled in the GLORIA-AF registry phase 2, depending on the antithrombotic therapy received, and to assess the potential for patient retention with dabigatran during a 2-year follow-up.Material and methods. In the Russian Federation, 408 patients were included in the second phase of GLORIA-AF which is a global prospective observational registry of newly diagnosed patients with AF. The patient characteristics are presented depending on received antithrombotic therapy (dabigatran, factor Xa inhibitors, vitamin K antagonist, antiplatelet agents, or no antithrombotic therapy), with a dabigatran dosing regimen of either 110 mg or 150 mg twice daily. Duration of patient retention on dabigatran therapy was also analyzed during a 2-year follow-up.Results. Of the 405 patients with recently diagnosed nonvalvular AF, 358 (88%) received oral anticoagulants (OAC), and 47 (12%) patients received antiplatelet drugs or received no antithrombotic therapy. Most patients were treated with dabigatran (n=275, 68%), and 75 (19%) patients received vitamin K antagonist. Clinical and demographic characteristics of patients receiving dabigatran were comparable with those in the general group of the Russian patients. The mean age was 63,5 years. The most common comorbidities in Russian patients receiving dabigatran were hypertension (93%), congestive heart failure (57%), coronary artery disease (35%). It is noteworthy that 12% and 10% of patients had a previous myocardial infarction and stroke, respectively. The mean CHA2DS2-VASc score for stroke risk for these patients was 3,2; 88% of patients had a high stroke risk (score of >2). Of the 275 patients with AF who received dabigatran therapy, 164 (60%) patients received dabigatran at the dose of 150 mg twice daily, and 111 (40%) patients received 110 mg twice daily. Dabigatran doses of 110 mg twice daily were more frequently prescribed for female patients aged 65 years or older and patients with a previous coronary events and impaired renal function, who had a higher CHA2DS2-VASc score for stroke risk. There was a higher proportion of AF patients with marked symptoms in the dabigatran 150 mg twice daily group. A median duration of treatment with dabigatran with the initial dosing regimen was 24 months. The estimated dabigatran therapy retention rate was 0,87, 0,81 and 0,73 after 6, 12 and 24 months of follow-up, respectively.Conclusion. In the Russian Federation, patients with newly diagnosed AF who have an increased risk of stroke are more likely to receive OAC therapy, such as direct thrombin inhibitor (dabigatran), compared to the global cohort of the GLORIA AF Registry Program. Patients in the Russian cohort receiving dabigatran differ from the global cohort of patients by greater comorbidity. At the same time, patients receiving reduced doses of dabigatran, both in the Russian Federation and in the global Registry, are characterized by a greater proportion of patients aged >75 years, a higher incidence of previous myocardial infarction, coronary artery disease, heart failure, impaired renal function, higher CHA2DS2-VASc score for stroke risk. The potential dabigatran therapy retention rate after 24 months in the Russian Federation and in the global cohort was high and amounted to about 70%.

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Adherence to direct oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

Zielinski

Rein

Teichert

et al. 2021

Pharmacoepidemiology and Drug

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Dabigatran Persistence and Outcomes Following Discontinuation in Atrial Fibrillation Patients from the GLORIA-AF Registry

Cited by 22 publications

References 26 publications

Methodological considerations for investigating oral anticoagulation persistence in atrial fibrillation

Methodological considerations for investigating oral anticoagulation persistence in atrial fibrillation

Clinical performance of the atrial fibrillation in the Russian population depending on the antithrombotic therapy: findings from the GLORIA-AF registry phase 2

Adherence to direct oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

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