Optimizing adherence and persistence to non-vitamin K antagonist oral anticoagulant therapy in atrial fibrillation

Abstract

Atrial fibrillation (AF) is associated with an increased risk of stroke, which can be prevented by the use of oral anticoagulation. Although non-vitamin K antagonist oral anticoagulants (NOACs) have become the first choice for stroke prevention in the majority of patients with non-valvular AF, adherence and persistence to these medications remain suboptimal, which may translate into poor health outcomes and increased healthcare costs. Factors influencing adherence and persistence have been suggested to be patient-related, physician-related, and healthcare system-related. In this review, we discuss factors influencing patient adherence and persistence to NOACs and possible problem solving strategies, especially involving an integrated care management, aiming for the improvement in patient outcomes and treatment satisfaction.

Contemporary trends and barriers to oral anticoagulation therapy in Non-valvular atrial fibrillation during DOAC predominant era

“…These results reflect a high proportion of patients that are still left unprotected from stroke risk or are otherwise not on guideline directed OAC therapy. Here we did not consider the adherence and persistence rates [13] for OAC therapy which are further likely to reduce the number of AF patients left unprotected against stroke. Although not directly comparable, these numbers seem comparable to the pre-DOAC era studies in the United States that were predominantly comprised of patients using VKA.…”

“…This is similar to some prior studies that have linked polypharmacy and worsening of health outcomes with low adherence to OAC therapy. [13] Thus, we emphasize a need to engage patients in a shared decision-making process and help direct them towards more beneficial treatment options or revisit the decision later. [20] Lastly, patients on OAC were more likely to have utilized other cardiac-related interventions such as catheter/surgical ablations, cardioversion, permanent pacemaker/defibrillator devices, prior percutaneous coronary intervention, or coronary artery bypass graft.…”

Percutaneous left atrial appendage closure: beyond the classic indications

“…If even in the general NVAF population in developed countries OAC adherence and persistence rates are far less than ideal, there are specific groups of patients for whom this problem is certainly more worrisome, such as people living in rural areas with difficult access to medical facilities, homeless people, patients who cannot afford medications, or patients with cognitive impairment and inadequate assistance 50 . LAAC has been nominated as a "mechanical vaccine" against stroke and ICH because it precludes compliance to an OAC regimen 51 .…”

Prevalence and Rate of Resolution of Left Atrial Thrombus in Patients with Non-Valvular Atrial Fibrillation: A Two-Center Retrospective Real-World Study

“…Non-vitamin K antagonist oral anticoagulants (NOACs) were demonstrated to be at least non-inferior to vitamin K antagonists (VKA) in preventing thromboembolism in randomized clinical trials (RCTs) [ 1 ]. The efficacy of NOACs in patients suitable for electrical cardioversion or with LAA thrombus diagnosis is increasingly supported by scientific evidence, even though patient adherence to this anticoagulant approach remains undetermined [ 4 , 5 ].…”