Persistence with Anticoagulation for Atrial Fibrillation: Report from the GLORIA-AF Phase III 1-Year Follow-up

Abstract

Background: We aimed to assess the extent to which drug persistence is better with non-vitamin K antagonist oral anticoagulants (NOACs) than vitamin K antagonists (VKAs) in atrial fibrillation (AF) patients and to estimate the difference in therapy persistence depending on NOAC dosing regimen (once daily (QD) vs. twice daily (BID)). Methods: Consecutive patients were followed for 1 year in phase III of the GLORIA-AF registry. Drug persistence was defined as the use of OAC without any discontinuation in >30 days or switching to alternative therapy. Results: Among 21,109 eligible patients in phase III, 17,266 patients who were prescribed OAC at baseline and those who took ≥1 OAC dose were included. The 1-year proportion of patients receiving NOAC and VKA who persisted on treatment was 80% and 75%, respectively. The 1-year persistence with NOACs BID and NOACs QD was 81% and 80%, respectively. Female gender, hypertension, older age, alcohol use, permanent, asymptomatic, and minimally symptomatic AF were associated with better OAC persistence. Region, medication usage predisposing to bleeding, being a current smoker, treatment reimbursement, and proton pump inhibitors were associated with lower OAC persistence. Conclusions: Drug persistence was higher with NOACs (1-year persistence was 80%) than with VKAs (75%). There was little difference in 1-year persistence between NOAC dosing regimens.

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

“…A recent study based on 1-year follow-up phase III data from GLORIA-AF registry 43 found that drug persistence was higher with NOACs than with VKAs, without a significant difference in persistence when comparing NOAC dosing regimens (once daily vs. twice daily). 44 Nonetheless, in other studies, once daily NOACs were shown to increase adherence in comparison to twice daily NOACs. 14 , 27 , 45–48 …”

Adherence and Persistence with Once-Daily vs Twice-Daily Direct Oral Anticoagulants Among Patients with Atrial Fibrillation: Real-World Analyses from the Netherlands, Italy and Germany

“…The present study was conducted in 205,773 AF new users of DOACs in the Netherlands, Italy and Germany between 2011 and 2018. To our knowledge, it represents the largest study of its type, being at least one order of magnitude larger than previous studies [ 17 ]. Across the three European countries, adherence was significantly lower with BID vs QD regimens, with marginal differences in the Netherlands and Italy, but marked in Germany, where formal nonadherence to BID regimens was reached (i.e.…”

“…Expert opinion recommends a QD dosage regimen DOAC in patients who prefer a low pill burden [ 16 ]. Contemporary studies assessing treatment adherence by QD or BID DOAC regimens are few and limited in size [ 17 ]. The objective of the present study is to assess, in three large real-life samples of patients with AF, the adherence, persistence and switching patterns of QD vs BID regimens in three different European countries.…”

Patients' experiences across the trajectory of atrial fibrillation: A qualitative systematic review

“…(5) Was the data collected in a way that addressed the research issue? (6) Has the relationship between the researcher and participants been adequately considered? (7) Have ethical issues been taken into consideration?…”

“…As the disease progresses, patients with AF experience various heart symptoms and physical discomfort 5 . Moreover, AF also affects psychological well‐being, social connectedness and quality of life (QoL) 6 …”