Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

Zielinski, G. Denise; Rein, Nienke van; Teichert, Martina; Klok, Frederikus A.; Rosendaal, Frits R.; Meer, F. J. M. Van Der; Huisman, Menno V.; Cannegieter, Suzanne C.; Lijfering, Willem M.

doi:10.1002/rth2.12261

Cited by 27 publications

(48 citation statements)

References 46 publications

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“…As was recently published by Zielinksi et al, the mean age of oral anticoagulant naïve patients (n = 70 977) in SFK was 70 years (SD, 11), 38 995 were male (55%), and 60 028 used comedication (85%). For patients in SFK who switched from VKA to DOAC (n = 6356) the mean age was 70 years (SD, 11), 3667 were male (58%), and 6323 used comedication (99%) (Table ).…”

Section: Resultsmentioning

confidence: 62%

“…For patients in SFK who switched from VKA to DOAC (n = 6356) the mean age was 70 years (SD, 11), 3667 were male (58%), and 6323 used comedication (99%) (Table ). In SFK data, persistence rates among patients with atrial fibrillation after 1 year of follow‐up was 77% for patients who switched from a VKA to a DOAC, while in the Monitoring of direct oral anti‐coagulant (MONDOAC) study the persistence rate was 94% for patients with atrial fibrillation (Table ) . In SFK data, the adherence rate for DOAC after 1 year of follow‐up was 88% for patients who switched from a VKA to a DOAC, this was also 88% for patients with atrial fibrillation in the MONDOAC study.…”

Section: Resultsmentioning

confidence: 99%

“…To study the generalizability and to assess the influence of a potential selection bias of our study results, we compared our results with data on DOAC use from the Dutch Foundation for Pharmaceutical Statistics (SFK), of which the methods and several results were published previously . In brief, SFK gathers pharmacy dispensing data from >95% of community pharmacies in the Netherlands.…”

Section: Methodsmentioning

confidence: 99%

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Self‐reported therapy adherence and predictors for nonadherence in patients who switched from vitamin K antagonists to direct oral anticoagulants

Toorop

Rein

Nierman³

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Background Many patients who used vitamin K antagonists (VKAs) for long‐term prevention of thromboembolism are now actively switched to a direct oral anticoagulant (DOAC). Strict adherence to a DOAC is crucial for its success. However, therapy adherence and clinical factors that predict nonadherence are currently not well studied among patients who switched from a VKA to a DOAC. Methods A questionnaire was developed and sent to 2920 former patients of 3 anticoagulation clinics in the Netherlands, who switched from a VKA to a DOAC between January 2016 and December 2017. Questions concerned demographics, treatment persistence, adherence, and the occurrence of bleeding or thromboembolic events on DOACs. To identify predictors for nonadherence, logistic regression models were used to estimate crude and age/sex‐adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). Results A total of 1399 questionnaires (response rate 48%) were used for analysis. DOAC treatment persistence (94%) and adherence (86%) rates were high. Several predictors of nonadherence were identified, including young age (OR, 5.9; 95% CI, 3.6‐9.8 for <60 years compared to >75 years), low consultation frequency with a specialist (OR, 1.6; 95% CI, 1.1‐2.2), a history of minor bleeding on DOACs (OR, 1.9; 95% CI, 1.3‐2.8), and a twice‐daily dosing regimen (OR, 1.9; 95% CI, 1.3‐2.6). Conclusions Self‐reported treatment persistence and adherence were high in our study population, and several predictors of nonadherence were identified. Factors that can be influenced (low consult frequency with medical specialist, daily dosing regimen) may be used to improve therapy adherence.

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Section: Resultsmentioning

confidence: 62%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Self‐reported therapy adherence and predictors for nonadherence in patients who switched from vitamin K antagonists to direct oral anticoagulants

Toorop

Rein

Nierman³

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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“…38,39 A Dutch study recently found that 34% of patients with newly diagnosed AF had stopped treatment with nonvitamin K antagonists after one year, with female sex being associated with a higher risk of nonadherence. 40 In summary, women are more likely than men to receive suboptimal anticoagulation, a difference not likely to be explained be differences in bleeding risk profiles. If the Sc Fig.…”

Section: Potential Clinical Consequences Of Changing the Risk Scorementioning

confidence: 99%

Female Sex as a Risk Modifier for Stroke Risk in Atrial Fibrillation: Using CHA2DS2-VASc versus CHA2DS2-VA for Stroke Risk Stratification in Atrial Fibrillation: A Note of Caution

Nielsen

Overvad

2020

Thromb Haemost

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Stroke prevention is a key clinical concern in the management of patients with atrial fibrillation. Oral anticoagulation treatment reduces the risk of disabling stroke, but the treatment increases the risk of bleeding. For decades, the decision to initiate oral anticoagulation has been guided by clinical risk scoring systems such as the CHADS2 and CHA2DS2-VASc scores. In this narrative review, we focus on the recent discussion of the “Sc” (Sex Category) criterion in the CHA2DS2-VASc score. Epidemiological considerations when assessing stroke rates in cohorts are discussed, and the implications of different methodological approaches are outlined. Next, we review studies investigating the association of the “Sc” criterion on the stroke rates under various approaches. Lastly, we discuss potential consequences of implementing the recently suggested sex-less CHA2DS2-VA score, which leaves out female sex from stroke risk assessment in atrial fibrillation.

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“…Based on a 1 year non-persistence in one-third of the NOAC users, 1815 patients on NOACs will be non-persistent. 36 If we assume a 50% increased risk of ischaemic stroke/systemic embolism in these patients, we can expect on average a 3% yearly risk compared with the 2% in the 3685 patients who will continue to use their drug. 7 During 2-year follow-up, we expect 250 patients will develop ischaemic stroke/systemic embolism.…”

Section: Methodsmentioning

confidence: 99%

Design and rationale of DUTCH-AF: a prospective nationwide registry programme and observational study on long-term oral antithrombotic treatment in patients with atrial fibrillation

et al. 2020

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IntroductionAnticoagulation therapy is pivotal in the management of stroke prevention in atrial fibrillation (AF). Prospective registries, containing longitudinal data are lacking with detailed information on anticoagulant therapy, treatment adherence and AF-related adverse events in practice-based patient cohorts, in particular for non-vitamin K oral anticoagulants (NOAC). With the creation of DUTCH-AF, a nationwide longitudinal AF registry, we aim to provide clinical data and answer questions on the (anticoagulant) management over time and of the clinical course of patients with newly diagnosed AF in routine clinical care. Within DUTCH-AF, our current aim is to assess the effect of non-adherence and non-persistence of anticoagulation therapy on clinical adverse events (eg, bleeding and stroke), to determine predictors for such inadequate anticoagulant treatment, and to validate and refine bleeding prediction models. With DUTCH-AF, we provide the basis for a continuing nationwide AF registry, which will facilitate subsequent research, including future registry-based clinical trials.Methods and analysisThe DUTCH-AF registry is a nationwide, prospective registry of patients with newly diagnosed ‘non-valvular’ AF. Patients will be enrolled from primary, secondary and tertiary care practices across the Netherlands. A target of 6000 patients for this initial cohort will be followed for at least 2 years. Data on thromboembolic and bleeding events, changes in antithrombotic therapy and hospital admissions will be registered. Pharmacy-dispensing data will be obtained to calculate parameters of adherence and persistence to anticoagulant treatment, which will be linked to AF-related outcomes such as ischaemic stroke and major bleeding. In a subset of patients, anticoagulation adherence and beliefs about drugs will be assessed by questionnaire.Ethics and disseminationThis study protocol was approved as exempt for formal review according to Dutch law by the Medical Ethics Committee of the Leiden University Medical Centre, Leiden, the Netherlands. Results will be disseminated by publications in peer-reviewed journals and presentations at scientific congresses.Trial registration numberTrial NL7467, NTR7706 (https://www.trialregister.nl/trial/7464).

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Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

Cited by 27 publications

References 46 publications

Self‐reported therapy adherence and predictors for nonadherence in patients who switched from vitamin K antagonists to direct oral anticoagulants

Self‐reported therapy adherence and predictors for nonadherence in patients who switched from vitamin K antagonists to direct oral anticoagulants

Female Sex as a Risk Modifier for Stroke Risk in Atrial Fibrillation: Using CHA2DS2-VASc versus CHA2DS2-VA for Stroke Risk Stratification in Atrial Fibrillation: A Note of Caution

Design and rationale of DUTCH-AF: a prospective nationwide registry programme and observational study on long-term oral antithrombotic treatment in patients with atrial fibrillation

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