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Published on: February 26, 2013
Adherence to dabigatran etexilate in atrial fibrillation patients intended to undergo electrical cardioversion
Willemijn J Comuth1,2,3, Moniek P M de Maat4, Daan van de Kerkhof5
1Department of Clinical Biochemistry, Regional Hospital of West Jutland, Gl. Landevej 61, Herning, Denmark.
Insights
Effective anticoagulation for atrial fibrillation requires high medication adherence. This study found that dabigatran plasma levels did not reliably reflect adherence, and satisfaction was not linked to it, highlighting potential concerns for electrical cardioversion (ECV) patient management.
Area of Science:
- Cardiology
- Pharmacology
- Patient Adherence Research
Background:
- Effective anticoagulation is crucial for patients undergoing electrical cardioversion (ECV) for symptomatic atrial fibrillation to prevent adverse events.
- High medication adherence is a prerequisite for successful anticoagulation therapy.
Purpose of the Study:
- To measure self-reported short- and long-term adherence to dabigatran in newly diagnosed atrial fibrillation patients undergoing ECV.
- To evaluate if dabigatran plasma concentrations correlate with adherence.
- To assess treatment satisfaction and its correlation with adherence.
Main Methods:
- Plasma concentrations of dabigatran were measured using liquid-chromatography tandem mass spectrometry.
- Self-reported adherence was assessed using the 8-point Morisky Medication Adherence Scale (MMAS-8).
- Treatment satisfaction was measured using the Anti-Clot Treatment Scale (ACTS).
Main Results:
- No significant relationship was found between adherence and plasma concentrations, except when the last intake was over 48 hours prior.
- After 7 weeks, 74% of patients showed high adherence (MMAS-8), which was lower than anticipated.
- Treatment satisfaction was high, but did not correlate with medication adherence.
Conclusions:
- The observed adherence rate of 74% is a concern for effective anticoagulation in patients undergoing ECV.
- Dabigatran plasma concentrations are not reliable indicators of adherence unless a significant time gap exists since the last dose.
- Treatment satisfaction does not appear to be a predictor of medication adherence in this patient group.
Aims:
Effective anticoagulation in patients undergoing electrical cardioversion (ECV) for symptomatic atrial fibrillation is important to prevent adverse events. High medication adherence is a requirement. In patients with newly diagnosed atrial fibrillation (n = 169) who were intended to undergo ECV, the aim of this study was to measure self-reported short- and long-term adherence, evaluate whether dabigatran plasma concentrations reflect adherence, measure treatment satisfaction and assess whether adherence and treatment satisfaction are correlated.
Methods And Results:
Plasma concentrations (liquid-chromatography tandem mass spectrometry), the 8-point Morisky Medication Adherence Scale (MMAS-8) and the Anti-Clot Treatment Scale (ACTS) were measured after 3 weeks and 7 weeks of treatment. Combined mean peak (1-3 h after intake) and trough (10-16 h after intake) plasma concentrations were 175 (SD 109) ng/mL and 75 (SD 45) ng/mL, respectively. There was no relationship between short-term adherence (last 3 days) or long-term adherence (last 3-4 weeks) and plasma concentrations, unless the last intake was more than 48 h ago. After 7 weeks high, moderate, and low adherence, according to the MMAS-8, was seen in 74%, 21%, and 5% of patients, respectively. Treatment satisfaction was high (median ACTS score 68.5, range 46-75 points). Treatment satisfaction and adherence were not correlated.
Conclusion:
The percentage of patients in the high adherence group (74%) was lower than expected, which is a matter of concern. Dabigatran plasma concentrations could not detect short- or long-term non-adherence, unless the drug was last taken more than 48 h ago. Treatment satisfaction did not correlate with adherence.
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