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Oral anticoagulant adherence and switching in patients with atrial fibrillation: A prospective observational study

Shahrzad Salmasi1, Abdollah Safari2, Anita Kapanen1

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

Research in Social & Administrative Pharmacy : RSAP
|June 26, 2022
PubMed

Insights

Patients with atrial fibrillation (AF) show high adherence to oral anticoagulants (OACs). Factors like older age and satisfaction with medication burden improve adherence, while drug class showed no significant difference.

Area of Science:

  • Cardiology
  • Pharmacology
  • Patient Adherence Research

Background:

  • Oral anticoagulants (OACs) are crucial for stroke prevention in atrial fibrillation (AF).
  • Limited data exists on psychosocial factors influencing OAC adherence and adherence across different OAC classes.
  • OAC switching patterns and determinants remain underexplored.

Purpose of the Study:

  • To prospectively assess OAC adherence and switching in AF patients.
  • To identify clinical, demographic, and psychosocial determinants of OAC adherence and switching.
  • To compare adherence between OAC drug classes.

Main Methods:

  • Prospective study design with AF patients recruited from specialized AF clinics in Canada.
  • Data collection via telephone surveys every 3-4 months for up to 2 years.
  • Adherence measured using the Morisky Medication Adherence scale (MMAS-8); OAC switching also recorded.

Main Results:

  • 306 participants followed for a median of 14.1 months; mean adherence (MMAS-8) was 7.28.
  • Higher adherence associated with older age, experiencing a bleed, and greater satisfaction with medication burden.
  • No significant difference in adherence between OAC drug classes; 7.8% switched OACs, primarily from warfarin to DOACs.

Conclusions:

  • AF patients generally report high adherence to OAC therapy.
  • Direct oral anticoagulants (DOACs) may not offer superior adherence compared to vitamin K antagonists (VKAs).
  • Enhancing patient satisfaction with medication burden is key to improving OAC adherence.
Abstract

Keywords:
AdherenceAnticoagulantsAtrial fibrillationPersistenceStroke preventionSwitch

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