Longitudinal Oral Anticoagulant Adherence Trajectories in Patients With Atrial Fibrillation

Salmasi, Shahrzad; Vera, Mary A. De; Safari, Abdollah; Lynd, Larry D.; Koehoorn, Mieke; Barry, Arden R.; Andrade, Jason G.; Deyell, Marc W.; Rush, Kathy L.; Zhao, Yinshan; Loewen, Peter

doi:10.1016/j.jacc.2021.09.1370

Cited by 27 publications

(31 citation statements)

References 29 publications

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“…Using administrative health data from 1996 to 2019 in British Columbia, Canada, a study examined oral anticoagulant adherence trajectories over 5 years in 19 749 patients with AF (mean age, 70.6 years; 56% male; mean CHA 2 DS 2 -VASc score, 2.8). 61 Group-based trajectory modeling identified 74% of patients as having “consistent adherence,” 12% as having “rapid decline and discontinuation,” 10% as having “rapid decline and partial recovery,” and 4% as having “slow decline and discontinuation.” 61 Clinical and demographic characteristics were not able to provide strong performance in predicting these adherence trajectories.…”

Section: Quality Of Carementioning

confidence: 99%

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

Tsao¹,

Aday²,

Almarzooq³

et al. 2023

Circulation

3,184

702

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BACKGROUND: The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS: The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year’s worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year’s edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

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Section: Quality Of Carementioning

confidence: 99%

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

Tsao¹,

Aday²,

Almarzooq³

et al. 2023

Circulation

3,184

702

View full text Add to dashboard Cite

show abstract

“…Only 30.9% of included patients administrated with anticoagulants, although 72.0% of patients has a CHA 2 DS 2 -VASc Score ≥2. Furthermore, the heterogeneity on gene polymorphism, oral anticoagulation adherence, socioeconomic factors may ultimately affect the formation of LAT in various population ( 22 ). In conclusion, as we report the results of a real-world patient population, we believe that the present findings represent a typical patient population encountered in daily clinical practice in China.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Thrombus in Patients With Non-valvular Atrial Fibrillation: A Cross-Sectional Study in China

Shu

Zhao

Liu

et al. 2022

Front. Cardiovasc. Med.

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BackgroundStroke is predominately attributed to left atrial thrombus (LAT) in patients with non-valvular atrial fibrillation (NVAF), however, its detection rate in real clinical practice has been few reported in China.ObjectiveThis study aimed to investigate the prevalence and associated factors of LAT in patients with NVAF in China.MethodsAll adult NVAF patients undergoing transesophageal echocardiography (TEE) in the China Atrial Fibrillation Center database from January 2017 to January 2022 were enrolled in this study. The prevalence of LAT was calculated, and associated factors were identified.ResultsA total of 36,007 NVAF inpatients from 602 hospitals in 30 provinces/autonomous regions/municipalities were included in the final analysis, with a median age of 66 years and 39.4% were female. LAT was present in 1,467 (4.1%) patients overall, 2.7, 5.7, and 6.8% in patients with paroxysmal, persistent, and long-standing persistent AF, respectively. In subgroup analysis, including age ≥ 65 years, CHA2DS2-VASC score ≥ 2, left atrial diameter (LAD) ≥ 50 mm, left ventricular ejection fraction (LVEF) < 50%, and anticoagulation, patients with paroxysmal AF always had the lowest LAT prevalence, followed by patients with persistent and long-standing persistent AF. Patients treated with anticoagulants had less prevalent LAT than those without anticoagulation (2.1 vs. 5.0%, p < 0.001). In multivariate analysis, AF pattern (both persistent AF and long-standing persistent AF), hypertension, chronic heart failure, coronary heart disease, transient ischemic attack/stroke, diabetes mellitus, and LAD (per 5 mm) were associated with an increased prevalence of LAT. However, LVEF (per 5%) and anticoagulation were associated with a reduced prevalence of LAT.ConclusionLAT was found in 4.1% of Chinese adult NVAF inpatients underwent TEE in real-world experience. The prevalence of LAT mainly associated with non-paroxysmal AF, cardiovascular diseases, diabetes mellitus, enlarged left atrium, lower LVEF, and lack of anticoagulation therapy.

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“…Salmasi and colleagues found similarly complex adherence patterns within patients taking anticoagulants for atrial fibrillation. 10 We found mixed results for the improved outcome prediction capacity of trajectory-based methods relative to binary classifications. This is in contrast with work by Liu and colleagues who demonstrated improved outcome prediction by using glycemic trajectories as a predictor rather than a simple diabetes diagnosis dichotomy.…”

Section: Discussionmentioning

confidence: 85%

Adherence trajectory as an on-treatment risk indicator among drug-resistant TB patients in the Philippines

Huddart

Geocaniga-Gaviola

Crowder

et al. 2022

Preprint

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IntroductionHigh levels of treatment adherence are critical for achieving optimal treatment outcomes among patients with tuberculosis (TB), especially for drug-resistant TB (DR TB). Current tools for identifying high-risk non-adherence are insufficient. Here, we apply trajectory analysis to characterize adherence behavior early in DR TB treatment and assess whether these patterns predict treatment outcomes.MethodsWe conducted a retrospective analysis of Philippines DR TB patients treated between 2013 and 2016. To identify unique patterns of adherence, we performed group-based trajectory modelling on adherence to the first 12 weeks of treatment. We estimated the association of adherence trajectory group with six-month and final treatment outcomes using univariable and multivariable logistic regression. We also estimated and compared the predictive accuracy of adherence trajectory group and a binary adherence threshold for treatment outcomes.ResultsOf 596 patients, 302 (50.7%) had multidrug resistant TB, 11 (1.8%) extremely drug-resistant (XDR) TB, and 283 (47.5%) pre-XDR TB. We identified three distinct adherence trajectories during the first 12 weeks of treatment: a high adherence group (n=483), a moderate adherence group (n=93) and a low adherence group (n=20). Similar patterns were identified at 4 and 8 weeks. Being in the 12-week moderate or low adherence group was associated with unfavorable six-month (adjusted OR [aOR] 3.42, 95% CI 1.90 - 6.12) and final (aOR 2.71, 95% 1.73 - 4.30) treatment outcomes. Adherence trajectory group performed similarly to a binary threshold classification for the prediction of final treatment outcomes (65.9 % vs. 65.4 % correctly classified), but was more accurate for prediction of six-month treatment outcomes (79.4% vs. 60.0% correctly classified).ConclusionsAdherence patterns are strongly predictive of patient treatment outcomes. Trajectory-based analyses represent an exciting avenue of research into TB patient adherence behavior seeking to inform interventions which rapidly identify and support patients with high-risk adherence patterns.

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Longitudinal Oral Anticoagulant Adherence Trajectories in Patients With Atrial Fibrillation

Cited by 27 publications

References 29 publications

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

Left Atrial Thrombus in Patients With Non-valvular Atrial Fibrillation: A Cross-Sectional Study in China

Adherence trajectory as an on-treatment risk indicator among drug-resistant TB patients in the Philippines

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