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Updated: Jun 15, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Group-based trajectory modeling to identify adherence patterns for direct oral anticoagulants in Medicare
Anjana Mohan1, Hua Chen1, Ashish A Deshmukh2
1College of Pharmacy, University of Houston, Health 2, Room 4048, 4349 Martin Luther King Boulevard, Houston, TX, 77204-5047, USA.
Insights
Direct oral anticoagulant (DOAC) adherence is suboptimal in atrial fibrillation (AF) patients, with significant predictors including age, gender, and comorbidities. Identifying adherence trajectories is crucial for managing cardiac and thromboembolic event risks.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Suboptimal adherence to direct oral anticoagulants (DOACs) in atrial fibrillation (AF) patients is a significant concern.
- This non-adherence increases the risk of cardiac and thromboembolic events.
Purpose of the Study:
- To identify distinct longitudinal adherence trajectories for DOACs in AF patients.
- To determine sociodemographic and clinical factors associated with each identified adherence trajectory.
Main Methods:
- Utilized Medicare Advantage Plan data for AF patients prescribed DOACs (July 2016-December 2017).
- Calculated monthly proportion of days covered (PDC) over a one-year follow-up.
- Employed logistic group-based trajectory modeling and multinomial regression to analyze adherence patterns and predictors.
Main Results:
- Identified four adherence trajectories in the general AF population: adherent (36.8%), gaps (9.3%), gradual decline (29.7%), and rapid decline (24.2%).
- Key predictors for suboptimal adherence included older age, male gender, low-income subsidy, prevalent DOAC use, and comorbidities.
- In incident users, three trajectories emerged: adherent (31.8%), rapid decline (32.5%), and gradual decline (35.6%), with predictors like gender, low-income subsidy, high HAS-BLED score, and coronary artery disease.
Conclusions:
- DOAC adherence was suboptimal across both the general AF population and incident users.
- Understanding these adherence patterns and associated factors is vital for improving patient outcomes and reducing event risks.
Background:
Suboptimal adherence to direct oral anticoagulants (DOACs) among atrial fibrillation (AF) patients remains currently a major concern due to the increased risk of cardiac and thromboembolic events.
Aim:
To identify longitudinal distinct trajectories of DOAC adherence and sociodemographic and clinical factors associated with each trajectory.
Method:
Patients with AF who were prescribed with DOAC from July 2016-December 2017 were identified among patients enrolled in the Medicare Advantage Plan. Patients were followed up for a year after the index date to calculate the monthly proportion of days covered (PDC). The monthly PDC was incorporated into the logistic group-based trajectory model to evaluate distinct patterns of adherence. A multinomial regression model was carried out to assess various predictors associated with each trajectory. Sub-group analysis was conducted among incident DOAC users.
Results:
Total of 1969 patients with AF, four distinct trajectories of adherence were selected: adherent 36.8%, gaps in adherence 9.3%, gradual decline in adherence 29.7%, and rapid decline in adherence 24.2%. Significant predictors associated with suboptimal adherence trajectories were age (75 years or older), gender (male vs female), low-income subsidy health plan, prevalent users, and presence of comorbidities. Among 933 incident users, three adherence trajectories were identified: adherent trajectory (31.8%), rapid decline in adherence (32.5%), and gradual decline in adherence (35.6%). The significant predictors among incident users were gender (male vs female), low-income subsidy health plan, HAS-BLED score ≥ 2, and presence of coronary artery disease.
Conclusion:
Adherence to DOACs was suboptimal among the total population and incident users.
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