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Cited by 88Atrial Fibrillation Management and OutcomesMedication Adherence and CompliancePharmaceutical Practices and Patient Outcomes

Real-world adherence and persistence with direct oral anticoagulants in adults with atrial fibrillation

Manzoor, Beenish S., Lee, Todd A., Sharp, Lisa K., Walton, Surrey M., Galanter, William L., Nutescu, Edith A.·2017·Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
DOI 10.1002/phar.1989
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Abstract

BACKGROUND: Evidence of adherence and persistence patterns in anticoagulation (AC) therapy comparing treatment-naïve and non-naïve patients is lacking. The objective of this study was to evaluate patterns of medication adherence and persistence in a real-world setting among AC-naïve and AC-experienced patients with atrial fibrillation (AF) who were treated with direct oral anticoagulants (DOACs). METHODS: AF patients newly initiating a DOAC with a minimum of 6 months of continuous health plan enrollment pre and postindex date (first DOAC prescription) were identified from the Truven Health MarketScan Commercial and Medicare Supplemental databases (2009-2013). DOAC adherence (proportion of days covered [PDC]), persistence, and predictors of adherence were assessed at 6 and 12 months postindex. RESULTS: Of 66,090 AF patients included, 46.6% (n=30,826) were AC naïve and 53.4% (n=35,264) were AC experienced (age: 66.9 ± 12.7 vs 70.4 ± 11.4 yrs, p<0.001; male: n=19,132 [62.1%] vs n=21,691 [61.5%], p=0.14, respectively). A majority of patients received dabigatran as their index DOAC (n=49,210; 74.5%). The mean PDC in AC-naïve versus AC-experienced patients at 6 and 12 months of follow-up was 72.3% versus 83.3% (p<0.001) and 63.7% versus 79.9% (p<0.001), respectively. Persistence with DOAC therapy in AC-naïve and AC-experienced patients at 6 and 12 months ranged from 59.3% and 76.3% (p<0.0001) to 31.6% and 50.2% (p<0.0001), respectively. Predictors of higher DOAC adherence were older age and higher number of concomitant medications. Predictors of lower adherence were higher number of comorbidities and AC-naïve user status. CONCLUSION: Medication adherence and persistence with DOACs declined over time and both were suboptimal and lower (at 6 and 12 mo postindex) in AC-naïve compared to AC-experienced patients. These findings can help target future strategies or interventions for patient education and long-term AC management especially in those patients naïve to DOAC therapy. Future investigation should examine potential reasons for differences in DOAC adherence and persistence between AC-experienced versus AC-naïve patients and the implications for patient outcomes.

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  • The low incidence of VTE had been reported in prior randomized controlled trials but had not been confirmed in real-world patients with less adherence.

    “It is interesting to note that the overall incidence of VTE was very low in both groups, which had been reported in prior randomized controlled trials (RCTs) but had not been confirmed in real-world patients with less adherence compared with randomized trial participants. 15,16”

    From Systematic review and meta-analysis of the efficacy and safety of apixaban compared to rivaroxaban in acute VTE in the real world (2019) · cites this paper as [16]

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Authors
Manzoor, B. S., Lee, T. A., Sharp, L. K., Walton, S. M., Galanter, W. L., & Nutescu, E. A.
Affiliations
University of Illinois Chicago (US)
Corresponding author
Nutescu, Edith A.
ORCID
Venue
Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
Publisher
Wiley
Published
2017-09-06
Volume
37
Issue
10
Pages
1221-1230
ISSN
  • 0277-0008 (ISSN-L)
  • 1875-9114
DOI
10.1002/phar.1989
OpenAlex
W2738405916
Cited by
88
References
39
Citations by year
2026: 2 · 2025: 3 · 2024: 8 · 2023: 4 · 2022: 6 · 2021: 16 · 2020: 19 · 2019: 14 · 2018: 14 · 2017: 2
FWCI
10.36
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Agency for Healthcare Research and Quality (U19HS021093)
  • National Heart, Lung, and Blood Institute (K23HL112908)
  • National Institute on Minority Health and Health Disparities (U54MD010723)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
direct oral anticoagulants, atrial fibrillation, medication adherence, treatment persistence, proportion of days covered, dabigatran, predictors of adherence, comorbidities, concomitant medications, real-world evidence, stroke prevention, Medicare Supplemental, commercial health plans, older adults
MeSH terms
Administration, Oral, Adult, Aged, Anticoagulants, Atrial Fibrillation, Female, Humans, Male, Middle Aged, Retrospective Studies, United States, Stroke, Medication Adherence

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