Adherence to dabigatran therapy and longitudinal patient outcomes: Insights from the Veterans Health Administration
| Autor: | Gary K. Grunwald, Supriya Shore, Thomas M. Maddox, Louise Pilote, Mintu P. Turakhia, Paul D. Varosy, Lucas N. Marzec, John S. Rumsfeld, P. Michael Ho, Evan P. Carey, Preston M Schneider, Cynthia A. Jackevicius, Steven M. Bradley, Anna E. Barón, Fran Cunningham |
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| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Myocardial Infarction Hemorrhage Article Antithrombins Dabigatran Medication Adherence Cohort Studies Risk Factors Internal medicine Atrial Fibrillation medicine Humans Myocardial infarction Longitudinal Studies Veterans Affairs Stroke Aged Retrospective Studies Aged 80 and over business.industry Atrial fibrillation Retrospective cohort study Middle Aged medicine.disease United States United States Department of Veterans Affairs Treatment Outcome Cohort Multivariate Analysis Physical therapy beta-Alanine Benzimidazoles Female Cardiology and Cardiovascular Medicine business Cohort study medicine.drug |
| Popis: | Dabigatran is a novel oral anti-coagulant (NOAC) that reduces risk of stroke in patients with non-valvular atrial fibrillation (NVAF). It does not require routine monitoring with laboratory testing which may have an adverse impact on adherence. We aimed to describe adherence to dabigatran in the first year after initiation and assess the association between non-adherence to dabigatran and clinical outcomes in a large integrated healthcare system.We studied a national cohort of 5,376 patients with NVAF, initiated on dabigatran between October-2010 and September-2012 at all Veterans Affairs hospitals. Adherence to dabigatran was calculated as proportion of days covered (PDC) and association between PDC and outcomes was assessed using standard regression techniques.Mean age of the study cohort was 71.3 ± 9.7 years; 98.3% were men and mean CHADS2 score was 2.4 ± 1.2 (mean CHA2DS2VASc score 3.2 ± 1.4). Median PDC was 94% (IQR 76%-100%; mean PDC 84% ± 22%) over a median follow-up of 244 days (IQR 140-351). A total of 1,494 (27.8%) patients had a PDC80% and were classified as non-adherent. After multivariable adjustment, lower adherence was associated with increased risk for combined all-cause mortality and stroke (HR 1.13, 95% CI 1.07-1.19 per 10% decrease in PDC). Adherence to dabigatran was not associated with non-fatal bleeding or myocardial infarction.In the year after initiation, adherence to dabigatran for a majority of patients is very good. However, 28% of patients in our cohort had poor adherence. Furthermore, lower adherence to dabigatran was associated with increased adverse outcomes. Concerted efforts are needed to optimize adherence to NOACs. |
| Databáze: | OpenAIRE |
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