Derivation and Validation of the Continue-One-Two-Hold Protocol for Optimizing Peri-Cardioversion Rate Control Medications

Abstract

BACKGROUND: Retrospective studies have shown that AF patients frequently discontinue, switch, or are non-adherent with oral anticoagulants (OAC). Few studies have explored AF patients' experiences with therapy and their behavior. This study characterized OAC persistence, switching, self-reported adherence, and therapy satisfaction in AF patients. METHODS AND RESULTS: Prospective cohort study involving telephone interviews every 3-4 months of AF patients from five specialized AF clinics in BC. We enrolled 388 patients [41% female, mean age 69 years (SD 10), CCS-SAF score 1.7 (SD 1.2), CHA2DS2-VASc 2.7 (SD 1.5), HAS-BLED 1.4 (SD 1.1)] and followed them for median 14.1 months/patient. Data was analyzed for the 357 participants who completed at least one follow up visit. Index OACs were rivaroxaban (38%), apixaban (28%), warfarin (25%), and dabigatran (9%). Permanent discontinuation or switches occurred in 55 participants (15%), and involved 25 discontinuations (rivaroxaban 10/133, dabigatran 2/33, apixaban 8/100, warfarin 5/91; no between-group differences) and