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Published on: February 28, 2012
Adherence to direct oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study
Gilda D Zielinski1, Nienke van Rein1,2, Martina Teichert2
1Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Insights
Direct oral anticoagulants (DOACs) adherence in atrial fibrillation patients was 76% overall, with younger patients and those without concomitant drug use showing lower adherence. Interventions are needed to improve DOAC treatment outcomes.
Area of Science:
- Pharmacology and Therapeutics
- Cardiology
- Real-World Evidence Studies
Background:
- Direct oral anticoagulants (DOACs) are crucial for managing atrial fibrillation (AF).
- Adherence to DOACs in clinical practice may differ from trial settings.
- Understanding real-world adherence is vital for effective AF management.
Purpose of the Study:
- To evaluate adherence to DOACs in a large cohort of AF patients in routine practice.
- To identify clinical predictors associated with non-adherence to DOAC therapy.
- To assess the impact of adherence on treatment persistence.
Main Methods:
- Utilized linked dispensing data from the Foundation for Pharmaceutical Statistics (2012-2016).
- Calculated one-year adherence using Proportion of Days Covered (PDC) ≥80%.
- Employed logistic regression to identify predictors of non-adherence and analyzed non-persistence (discontinuation within 1 year).
Main Results:
- Included 4797 apixaban, 20454 rivaroxaban, and 18477 dabigatran users (mean age 69 years).
- Overall adherence (PDC ≥80%) was 76%, with highest rates for apixaban (87%), followed by dabigatran (80%) and rivaroxaban (69%).
- Younger age (≤60 years) and absence of concomitant drug use predicted non-adherence. Patients who discontinued DOACs within a year had significantly lower adherence (56%) compared to those who continued (97%).
Conclusions:
- Non-adherence to DOACs in AF patients is linked to younger age and lack of concomitant medication.
- Lower adherence is a predictor of early DOAC treatment discontinuation.
- Findings underscore the need for targeted interventions to enhance DOAC adherence and persistence in everyday practice.
Background:
Adherence to direct oral anticoagulants (DOACs) in patients with atrial fibrillation in every day practice may be less than in clinical trials.
Aims:
To assess adherence to DOACs in atrial fibrillation patients in every day practice and identify predictors for non-adherence.
Methods:
Individual linked dispensing data of atrial fibrillation patients who used DOACs were obtained from the Foundation for Pharmaceutical Statistics covering the Netherlands between 2012 and 2016. One year adherence to DOAC was calculated for initial DOAC as proportion of days covered (PDC) ≥80% and the association between clinical variables and adherence was assessed using logistic regression. In addition, we measured non-persistence, that is, patients who completely stopped their initial DOAC within 1 year follow-up.
Results:
A total of 4797 apixaban-, 20 454 rivaroxaban- and 18 477 dabigatran users were included. The mean age was 69 years (n = 43 910), which was similar for the DOAC types. The overall proportion of patients with PDC ≥80% was 76%, which was highest for apixaban- (87%), followed by dabigatran- (80%) and rivaroxaban (69%) users. Multivariable analyses revealed that age ≤60 years, no concomitant drug use were predictors for non-adherence. Of atrial fibrillation patients who continued treatment, 97% had a PDC ≥80%, compared with only 56% for those who discontinued their DOAC treatment within 1 year.
Conclusions:
Non-adherence to DOACs was associated with age ≤60 years and no concomitant drugs use. Non-adherence was higher in patients who later discontinued DOAC treatment. Results of our study support research into interventions to improve adherence.
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