A Real-World Evaluation of Primary Medication Nonadherence in Patients with Nonvalvular Atrial Fibrillation Prescribed Oral Anticoagulants in the United States

• Published in: American journal of cardiovascular drugs : drugs, devices, and other interventions devices, and other interventions, 2023-09, Vol.23 (5), p.559-572
• Main Authors: Hernandez, Inmaculada, Divino, Victoria, Xie, Lin, Hood, David W., DeKoven, Mitch, Kariuki, Wanjiku, Bell, Griffith, Russ, Cristina, Cheng, Dong, Cato, Matthew, Atreja, Nipun, Hines, Dionne M.
• Format: Article
• Language: English
• Subjects: Anticoagulants; Cardiac arrhythmia; Cardiology; Costs; Electronic health records; Health care expenditures; Health care policy; Heart; Medicaid; Medicare; Medicine; Medicine & Public Health; Original Research Article; Patient compliance; Patients; Pharmacology/Toxicology; Pharmacotherapy; Pharmacy; Stroke; Thromboembolism
• ISSN: 1175-3277; 1179-187X
• DOI: 10.1007/s40256-023-00588-3

Background Nonadherence to oral anticoagulants (OACs) is a challenge to stroke risk reduction in patients with nonvalvular atrial fibrillation (NVAF). Data on primary medication nonadherence (PMN) in NVAF are lacking. Objectives Our aim was to assess the rates and predictors of PMN among NVAF patients who were newly prescribed an OAC. Methods This was a retrospective database analysis of linked healthcare claims and electronic health record data. Adult NVAF patients with a prescription order for an OAC (apixaban, rivaroxaban, dabigatran, or warfarin) between January 2016 and June 2019 were identified (date of first prescription order = index date). Patients had a 1-year baseline and a 6-month post-index period to assess the rates of PMN, defined as having a prescription order but no paid claim for any OAC on or within 30 days after the index date. Sensitivity analyses explored 60-, 90- and 180-day PMN thresholds. Logistic regression models were used to examine the predictors of PMN. Results Among 20,393 patients, the overall 30-day PMN rate was 28.4%; PMN rates decreased to 17% with a 180-day threshold. PMN was numerically lowest for warfarin among OACs and numerically lowest for apixaban among direct OACs. A CHA 2 DS 2 -VASc score of ≥ 3, commercial insurance, and African American race were associated with higher odds of PMN. Conclusions More than one-quarter of patients experienced PMN within 30 days of their initial prescription order. This rate decreased over a longer period, suggesting a delay in fills. Understanding the factors associated with PMN is warranted to develop effective interventions for improving OAC treatment rates in NVAF.