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Updated: Oct 24, 2025
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
[THE COMPLIANCE AND ADHERENCE TO DIRECT ORAL ANTICOAGULANTS IN PATIENTS WITH A TRIAL FIBRILLATION AFTER
Avishy Elis1,2, Gida Ayada1, Ibrahim Othman1
1Department of Internal Medicine "C", Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.
Insights
Direct oral anticoagulants (DOACs) for non-valvular atrial fibrillation show poor patient compliance and adherence, regardless of when regulatory approval is granted. This real-world study highlights challenges in long-term medication management for these patients.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Direct oral anticoagulants (DOACs) are recommended for non-valvular atrial fibrillation (NVAF).
- Regulatory approval processes can impact medication initiation and adherence.
- Understanding real-world adherence is crucial for effective NVAF management.
Purpose of the Study:
- To assess short-term (30-day) and long-term (12-month) compliance and adherence to DOACs in NVAF patients.
- To investigate the association between the timing of regulatory approval (during vs. after hospitalization) and DOAC adherence.
- To evaluate real-world adherence rates in a large patient cohort.
Main Methods:
- Retrospective study of 263 NVAF patients at Beilinson Hospital (2017-2018) who initiated DOACs during hospitalization.
- Data collected on regulatory approval timing, 30-day compliance, and 12-month adherence.
- Comparison of adherence rates between patients receiving approval during hospitalization versus after discharge.
Main Results:
- Only 23% of patients received DOAC approval during hospitalization; 77% received it post-discharge (median 3 days).
- Overall 30-day DOAC compliance was 60%, and 12-month adherence was 57%.
- No significant association found between approval timing and 30-day compliance or 12-month adherence.
Conclusions:
- Short- and long-term adherence to DOACs for NVAF is suboptimal.
- The timing of regulatory approval does not appear to significantly influence DOAC adherence in this real-world setting.
- Strategies to improve long-term DOAC adherence in NVAF patients are needed.
Introduction:
Guidelines recommend direct oral anticoagulants (DOACs) for the treatment of non-valvular atrial fibrillation. The heads of the medicine wards in Beilinson Hospital were nominated for regulatory approval of these agents for Clalit Health Services (CHS) patients.
Objectives:
To estimate the short and long term compliance and adherence to DOACs, and their association with the approval during hospitalization.
Methods:
A retrospective study was conducted on patients hospitalized at the medical wards of Beilinson Hospital during 2017 and the first 6 months of 2018. Inclusion criteria: age>18 years, members of CHS, have non-valvular atrial fibrillation and DOACs were started during their hospitalization. Data was evaluated for: the rate of approvals during hospitalization, the time needed for it after discharge, the 30 days and 12 months compliance and adherence to DOACs agents and their association with approval during hospitalization.
Results:
During the study period DOACs were started in 373 patients; 263 (71%) of them were included in the study: 59 patients (23%) received the approval during hospitalization, while 204 (77%) received it after discharge within a median of 3 days (range 1-10). There were no significant differences between the two groups concerning demographic, clinical parameters or length of stay. The DOACs 30-days compliance was 60% and 12-months adherence was 57%. There was a slight association between 30 days compliance and in-hospital approval (63% vs. 57%, p=0.3), while the 12 months adherence revealed the opposite (54% vs. 61%, p=0.5).
Conclusions:
The short and long term compliance and adherence to DOACs is poor, regardless of the timing of the regulatory approval.
Discussion:
These findings represent the real world situation, other studies revealed different results according to the study populations and methods.
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