Prevalence and Predictors of Nonadherence to Direct Oral Anticoagulant Treatment in Patients with Atrial Fibrillation.

Autor: van der Horst SFB; Department of Thrombosis and Hemostasis, Leiden UMC, Leiden, The Netherlands., de Vries TAC; Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Heart Center, Amsterdam, The Netherlands.; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands.; Department of Cardiology, Hospital Rijnstate, Arnhem, The Netherlands., Chu G; Department of Thrombosis and Hemostasis, Leiden UMC, Leiden, The Netherlands.; Department of Internal Medicine, Alrijne Hospital, Leiden, The Netherlands., Bavalia R; Department of Vascular Medicine, Amsterdam UMC location University of Amsterdam, The Netherlands.; GGD Amsterdam, Amsterdam, The Netherlands., Xiong H; IQVIA Netherlands, Amsterdam, The Netherlands., van de Wiel KM; IQVIA Netherlands, Amsterdam, The Netherlands., Mulder K; IQVIA Netherlands, Amsterdam, The Netherlands., van Ballegooijen H; IQVIA Netherlands, Amsterdam, The Netherlands., de Groot JR; Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Heart Center, Amsterdam, The Netherlands.; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands., Middeldorp S; Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands., Klok FA; Department of Thrombosis and Hemostasis, Leiden UMC, Leiden, The Netherlands., Hemels MEW; Department of Cardiology, Hospital Rijnstate, Arnhem, The Netherlands.; Department of Cardiology, Radboudumc, Nijmegen, The Netherlands., Huisman MV; Department of Thrombosis and Hemostasis, Leiden UMC, Leiden, The Netherlands.
Jazyk: angličtina
Zdroj: TH open : companion journal to thrombosis and haemostasis [TH Open] 2023 Sep 27; Vol. 7 (3), pp. e270-e279. Date of Electronic Publication: 2023 Sep 27 (Print Publication: 2023).
DOI: 10.1055/a-2161-0928
Abstrakt: Background  For most patients with newly diagnosed atrial fibrillation (AF), direct oral anticoagulants (DOACs) are preferred over vitamin K antagonists. However, there is concern that the lack of monitoring may impair therapy adherence and therefore the anticoagulant effect. Objective  To assess 1-year DOAC nonadherence in patients with AF and a treatment indication of at least 1 year in the Dutch health care setting, and to identify predictors of nonadherence. Methods  We performed a near-nationwide historical cohort study in patients with a novel DOAC indication for AF. Data were obtained from a pharmacy database, covering 65% of all outpatient prescriptions dispensed in the Netherlands. The 1-year nonadherence was assessed by the proportion of days covered; the threshold was set at <80%. Robust Poisson regression analyses were performed to identify predictors of nonadherence. Results  A total of 46,211 patients were included and the 1-year nonadherence was 6.5%. We identified male sex (risk ratio [RR] 1.23, 95% confidence interval [CI]: 1.15-1.33), younger age (age ≥60 to <70 years: RR: 1.15, 95% CI: 1.00-1.33, age <60 years: RR: 2.22, 95% CI: 1.92-2.57; reference age ≥85 years), a reduced DOAC dose (RR: 1.10, 95% CI: 1.00-1.22), a twice-daily dosing regimen (RR: 1.21, 95% CI: 1.12-1.30), and treatment with apixaban (RR: 1.16, 95% CI: 1.06-1.26, reference rivaroxaban) or dabigatran (RR: 1.25, 95% CI: 1.14-1.37) as independent predictors of 1-year nonadherence. Conclusion  One-year nonadherence to DOACs was low yet relevant in patients with AF newly prescribed a DOAC. Understanding the predictors for nonadherence may help identify patients at risk.
Competing Interests: Conflict of Interest T.A.C.d.V. reports nonfinancial support from Daiichi Sankyo, and speaker fees from both Bristol-Myers Squibb and speakers bureaus; all unrelated to this work. He also reports that he is being considered for the adjudication committee of the LIMIT & DANCE trials, which are sponsored by the Population Health Research Institute. K.M., K.M.v.d.W., and H.v.B. are employees of IQVIA, and H.X. is a former employee. J.R.d.G. reports research grants to his institution from AtriCure, Bayer, Boston Scientific, Daiichi Sankyo, Johnson & Johnson, and Medtronic; and consultancy/speaker fees from Atricure, Bayer, Berlin Chemie, Daiichi Sankyo, Menarini, Novartis, and Servier, all unrelated to this work. S.M. reports grants from GSK, BMS/Pfizer, Aspen, Daiichi Sankyo, Bayer, Boehringer Ingelheim, Sanofi, and Portola/Alexion, all unrelated to this work. F.A.K. reports grants or contracts from Bayer, BMS, BSCI, MSD, Leo Pharma, Actelion, Farm-X, The Netherlands Organisation for Health Research and Development, The Dutch Thrombosis Association, The Dutch Heart Foundation, and the Horizon Europe Program, all unrelated to this work and paid to his institution. M.E.W.H. reports speaker fees from BMS/Pfizer, Daiichi Sankyo, Bayer, Boehringer Ingelheim, and a research grant from Netherlands Federation of Anticoagulation clinics, all unrelated to this work. M.V.H. reports research grants from Dutch Healthcare Fund, Dutch Heart Foundation, Boehringer-Ingelheim, Pfizer-BMS, Bayer Health Care, and Leo Pharma, all unrelated to this work. The other authors have no conflicts of interest to declare.
(The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ ).)
Databáze: MEDLINE
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