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Adherence to direct or vitamin K antagonist oral anticoagulants in patients with atrial fibrillation: a long-term observational study.
Salmasi, Shahrzad; Safari, Abdollah; De Vera, Mary A; Högg, Tanja; Lynd, Larry D; Koehoorn, Mieke; Barry, Arden R; Andrade, Jason G; Deyell, Marc W; Rush, Kathy L; Zhao, Yinshan; Loewen, Peter.
Afiliación
  • Salmasi S; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver Campus, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
  • Safari A; Department of Mathematics, Statistics, and Computer Science, University of Tehran, Tehran, Iran.
  • De Vera MA; Department of Data Analytics, Statistics and Informatics, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.
  • Högg T; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver Campus, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
  • Lynd LD; Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada.
  • Koehoorn M; Department of Statistics, University of British Columbia, Vancouver, BC, Canada.
  • Barry AR; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver Campus, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
  • Andrade JG; Centre for Health Evaluation & Outcome Sciences, Providence Health Care Research Institute, Vancouver, BC, Canada.
  • Deyell MW; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
  • Rush KL; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
  • Zhao Y; Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver Campus, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
  • Loewen P; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
J Thromb Thrombolysis ; 57(3): 437-444, 2024 Mar.
Article en En | MEDLINE | ID: mdl-38103148
ABSTRACT
Our objectives were to measure long-term adherence to oral anticoagulants (OACs) in patients with atrial fibrillation (AF) and to identify patient factors associated with adherence. Using linked, population-based administrative data from British Columbia, Canada, an incident cohort of adults prescribed OACs for AF was identified. We calculated the proportion of days covered (PDC) as a time-dependent covariate for each 90-day window from OAC initiation until the end of follow-up. Associations between patient attributes and adherence were assessed using generalized mixed effect linear regression models. 30,264 patients were included. Mean PDC was 0.69 (SD 0.28) over a median follow-up of 6.7 years. 54% of patients were non-adherent (PDC < 0.8). After controlling for confounders, factors positively associated with adherence were number of drug class switches, history of stroke or transient ischemic attack, history of vascular disease, time since initiation, and age. Age > 75 years at initiation, polypharmacy (among VKA users only), and receiving DOAC (vs. VKA) were negatively associated with adherence. PDC decreased over time for VKA users and increased for DOAC users. Over half of AF patients studied were, on average, nonadherent to OAC therapy and missed 32% of their doses. Several patient factors were associated with higher or lower adherence, and adherence to VKA declined during therapy while DOAC adherence increased slightly over time. To min im ize the risk stroke, adherence-supporting interventions are needed for all patients with AF, particularly those aged > 75 years, those with prior stroke or vascular disease, VKA users with polypharmacy, and DOAC recipients.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Ataque Isquémico Transitorio / Accidente Cerebrovascular Límite: Adult / Humans Idioma: En Revista: J Thromb Thrombolysis Asunto de la revista: ANGIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Países Bajos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Ataque Isquémico Transitorio / Accidente Cerebrovascular Límite: Adult / Humans Idioma: En Revista: J Thromb Thrombolysis Asunto de la revista: ANGIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Países Bajos