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Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study

Amitava Banerjee1,2, Valerio Benedetto3, Philip Gichuru4

  • 1Institute of Health Informatics, University College London, London, UK ami.banerjee@ucl.ac.uk.

Heart (British Cardiac Society)
|October 12, 2019
PubMed

Insights

Direct oral anticoagulants (DOACs) show suboptimal adherence and persistence in atrial fibrillation (AF) patients. Understanding factors influencing these trends is crucial for improving stroke prevention strategies.

Area of Science:

  • Pharmacovigilance
  • Real-world evidence in cardiovascular medicine
  • Electronic Health Records (EHR) data analysis

Background:

  • Direct oral anticoagulants (DOACs) offer simpler regimens than vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF).
  • However, adherence and persistence to DOACs remain suboptimal and are understudied in electronic health records (EHRs).

Purpose of the Study:

  • To investigate time trends in adherence and persistence to oral anticoagulants (OACs) at individual and system levels.
  • To identify risk factors associated with adherence and persistence in adults with incident AF.

Main Methods:

  • Analysis of UK primary care EHR data (2011-2016) for adults with incident AF.
  • Assessment of adherence and persistence at 1 year for various OACs using Cox and logistic regression.
  • Examination of baseline characteristics and patterns of adherence/persistence.

Main Results:

  • Adherence at 1 year varied by OAC (51.2% for VKA to 66.5% for dabigatran).
  • Persistence at 1 year also showed heterogeneity (61.4% for dabigatran to 78.7% for apixaban).
  • Non-adherence and non-persistence risks increased over time; higher comorbidity was linked to reduced risk.

Conclusions:

  • Adherence and persistence to OACs are low at 1 year, with significant drug-specific and temporal variations.
  • Understanding the factors influencing these patterns is essential for developing interventions to improve OAC use in AF patients.
  • Findings highlight the need for strategies to enhance long-term adherence and persistence for effective stroke prevention.
Abstract

Keywords:
adherenceanticoagulantatrial fibrillationpersistencestroke

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