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CC BY 4.0 · TH Open 2023; 07(03): e270-e279
DOI: 10.1055/a-2161-0928
Original Article

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

Sabine F. B. van der Horst    *
1   Department of Thrombosis and Hemostasis, Leiden UMC, Leiden, The Netherlands
,
Tim A.C. de Vries    *
2   Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Heart Center, Amsterdam, The Netherlands
3   Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
4   Department of Cardiology, Hospital Rijnstate, Arnhem, The Netherlands
,
Gordon Chu
1   Department of Thrombosis and Hemostasis, Leiden UMC, Leiden, The Netherlands
5   Department of Internal Medicine, Alrijne Hospital, Leiden, The Netherlands
,
Roisin Bavalia
6   Department of Vascular Medicine, Amsterdam UMC location University of Amsterdam, The Netherlands
7   GGD Amsterdam, Amsterdam, The Netherlands
,
Helen Xiong
8   IQVIA Netherlands, Amsterdam, The Netherlands
,
Kayleigh M. van de Wiel
8   IQVIA Netherlands, Amsterdam, The Netherlands
,
Kelly Mulder
8   IQVIA Netherlands, Amsterdam, The Netherlands
,
Hanne van Ballegooijen
8   IQVIA Netherlands, Amsterdam, The Netherlands
,
Joris R. de Groot
2   Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Heart Center, Amsterdam, The Netherlands
3   Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, The Netherlands
,
Saskia Middeldorp
9   Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
,
Frederikus A. Klok 
1   Department of Thrombosis and Hemostasis, Leiden UMC, Leiden, The Netherlands
,
Martin E.W. Hemels
4   Department of Cardiology, Hospital Rijnstate, Arnhem, The Netherlands
10   Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
,
Menno V. Huisman
1   Department of Thrombosis and Hemostasis, Leiden UMC, Leiden, The Netherlands
› Author Affiliations Funding There is no funding to report.
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Abstract

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.

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Keywords

direct oral anticoagulant - anticoagulants - medication adherence - atrial fibrillation

Author Contributions

All authors have contributed to the concept and design of the study. S.F.B.v.d.H., T.A.C.d.V. and G.C. conducted the analyses. S.F.B.v.d.H., T.A.C.d.V., G.C., H.X., K.M.v.d.W., H.v.B., and M.V.H. contributed to the interpretation of data. S.F.B.v.d.H. wrote the first draft of the manuscript. T.A.C.d.V., G.C., R.B., H.X., K.M.v.d.W., K.M., H.v.B., J.R.d.G., S.M., F.A.K., M.E.W.H., and M.V.H. contributed to critical revision of the manuscript for important intellectual content and gave approval of the final version to be published. M.V.H. was the study supervisor.


* Co-first authorship.


Supplementary Material



Publication History

Received: 05 May 2023

Accepted: 25 August 2023

Accepted Manuscript online:
28 August 2023

Article published online:
27 September 2023

© 2023. 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/)

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