Adherence with direct oral anticoagulants in patients with atrial fibrillation: Trends, risk factors, and outcomes

Background Adherence to direct oral anticoagulants (DOACs) remains a concern among non‐valvular atrial fibrillation (AF) patients. We aimed to assess patterns of adherence with DOACs and examine their association with ischemic stroke and systemic embolism (SE). Methods This retrospective cohort stud...

Full description

Saved in:
Bibliographic Details
Published in:Journal of arrhythmia 2022-02, Vol.38 (1), p.67-76
Main Authors: Arbel, Anat, Abu‐Ful, Zomoroda, Preis, Meir, Cohen, Shai, Saliba, Walid
Format: Article
Language:English
Subjects:
Anticoagulants
Apixaban
Atrial fibrillation
Cardiac arrhythmia
direct‐acting oral anticoagulants
Drug stores
Health care industry
Health insurance
Health maintenance organizations
Health services
HMOs
Ischemia
Laboratories
Medical research
Medicine, Experimental
Original
Patient compliance
Patient outcomes
Pharmacy
Population
Risk factors
Rivaroxaban
Stroke
Stroke (Disease)
treatment adherence
Trends
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background Adherence to direct oral anticoagulants (DOACs) remains a concern among non‐valvular atrial fibrillation (AF) patients. We aimed to assess patterns of adherence with DOACs and examine their association with ischemic stroke and systemic embolism (SE). Methods This retrospective cohort study includes all adult members of Clalit Health Services, the largest healthcare provider in Israel, with newly diagnosed non‐valvular AF between January 2014 and March 2019, who initiated DOACs within 90 days of AF diagnosis and used DOACs exclusively. Adherence was assessed using the proportion of days covered (PDC) over the first year of treatment, and high adherence was defined as PDC ≥80%. Regression models were used to identify predictors of high adherence to DOACs and to examine the association between adherence and stroke or SE. Results Overall 15,255 patients were included in this study. The proportion of highly adherent (PDC ≥80%) DOACs users was around 75% and decreased slightly over the years. On multivariable analyses, the likelihood of high adherence to DOACs increased with age and across higher socioeconomic classes, and was more likely among females, Jews, statins users, and patients with CHA2DS2‐VASc score ≥2. Risk of stroke and SE was lower among highly adherent DOACs users; adjusted HR 0.56 (95% CI, 0.45–0.71), compared to users with PDC
ISSN:1880-4276
1883-2148
DOI:10.1002/joa3.12656