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Longitudinal Oral Anticoagulant Adherence Trajectories in Patients With Atrial Fibrillation

Shahrzad Salmasi1, Mary A De Vera2, Abdollah Safari3

  • 1Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, British Columbia, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

Journal of the American College of Cardiology
|December 10, 2021
PubMed

Insights

Most patients with atrial fibrillation (AF) show consistent oral anticoagulant adherence, but nonadherence varies dynamically. Clinical factors poorly predict these adherence trajectories, necessitating further research into patient behaviors.

Area of Science:

  • Pharmacoeconomics and Health Outcomes Research
  • Cardiology and Cardiovascular Diseases
  • Health Services Research

Background:

  • Traditional adherence measures fail to capture the dynamic nature of medication adherence.
  • Understanding long-term adherence patterns is crucial for effective treatment management in atrial fibrillation (AF).

Purpose of the Study:

  • To identify and characterize distinct long-term oral anticoagulant adherence trajectories in patients with AF.
  • To investigate demographic and clinical factors associated with these adherence patterns.

Main Methods:

  • Utilized linked population-based administrative health data from British Columbia, Canada (1996-2019).
  • Employed group-based trajectory modeling to analyze 5-year oral anticoagulant adherence (proportion of days covered).
  • Applied multinomial regression to identify predictors of adherence trajectories.

Main Results:

  • Identified four distinct 5-year oral anticoagulant adherence trajectories among 19,749 AF patients.
  • The majority (74%) exhibited "consistent adherence"; others showed patterns of decline and discontinuation (12%), decline with partial recovery (10%), or slow decline (4%).
  • Few demographic or clinical variables were associated with specific adherence trajectories.

Conclusions:

  • Significant heterogeneity exists in nonadherence patterns, with varying rates and timing of medication decline.
  • Current clinical and demographic data are insufficient for predicting individual patient adherence trajectories.
  • Findings suggest a need for tailored adherence interventions and qualitative research to explore psychosocial determinants of adherence behaviors.
Abstract

Keywords:
adherenceanticoagulantsatrial fibrillationgroup-based trajectory modelingproportion of days coveredtrajectory

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