OC 74.4 - Prevalence and Predictors of Non-Adherence to Direct Oral Anticoagulant Treatment in Patients with Atrial Fibrillation, a Historical Cohort Study

Wednesday, June 28, 2023

11:00 – 11:15 ET

Room: 511

Session Available As: On-Demand

Presenting Author(s)

Sabine F.B van der Horst, MD (she/her/hers)

MD, PhD-student
Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands

Co-Author(s)

Td

Tim A.C. de Vries

MD, PhD-student
Amsterdam UMC location University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery
Amsterdam, Noord-Holland, Netherlands
GC

Gordon Chu

MD, PhD-student
Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
RB

Roisin Bavalia

MD, PhD
Amsterdam UMC location University of Amsterdam, Department of Vascular Medicine, the Netherlands
Amsterdam, Noord-Holland, Netherlands
HX

Helen Xiong

MSc
IQVIA Netherlands, Amsterdam, the Netherlands
Amsterdam, Noord-Holland, Netherlands
Kv

Kayleigh M. van de Wiel

MSc
IQVIA Netherlands, Amsterdam
Amsterdam, Noord-Holland, Netherlands
KM

Kelly Mulder

MSc
IQVIA Netherlands, Amsterdam
Amsterdam, Noord-Holland, Netherlands
Hv

Hanne van Ballegooijen

MSc, PhD
IQVIA Netherlands, Amsterdam, the Netherlands
Amsterdam, Noord-Holland, Netherlands
Jd

Joris R. de Groot

MD, PhD
Amsterdam UMC location University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery
Amsterdam, Noord-Holland, Netherlands
Saskia Middeldorp, MD PhD

Professor
Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
Nijmegen, Gelderland, Netherlands
Erik Klok, MD, PhD, FESC

Leiden University Medical Center
MH

Martin E.W. Hemels

MD, PhD
Rijnstate Hospital, Department of Cardiology, Arnhem, the Netherlands
Arnhem, Gelderland, Netherlands
MH

Menno V. Huisman

MD, PhD
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands

Background: For most patients newly diagnosed with atrial fibrillation (AF), direct oral anticoagulants (DOACs) are regarded as the preferred anticoagulant treatment. However, there is concern that the lack of monitoring may impair therapy adherence.

Aims: To assess DOAC non-adherence in patient with AF in the Dutch healthcare setting, and to identify predictors of non-adherence.

Methods: We performed a historical cohort study in patients with a novel DOAC indication for AF, who had a treatment indication for at least one year and filled at least two DOAC prescriptions. Data was obtained from a pharmacy database, covering 65% of all outpatient prescriptions dispensed in the Netherlands. The one-year non-adherence was assessed by the proportion of days covered (PDC). The threshold for adequate adherence was set at 80%. Logistic regression analyses were performed to identify determinants associated with non-adherence.

Results: 46.211 patients were included in this study, and one-year non-adherence was 6.5%. We identified male sex (OR 1.17, 95% CI 1.09 – 1.26), age < 65 years (OR 1.56, 95%CI 1.43 – 1.71) and use of dabigatran (OR 1.13, 95% CI 1.03 – 1.24) as predictors for non-adherence. When evaluating dosing regimen instead of DOAC type, a dosing regimen of twice daily was a predictor of non-adherence (OR 1.15, 95%CI 1.07 – 1.24). Concomitant medication use (≥ 4 drug classes: OR 0.40, 95%CI 0.36 – 0.45) and a prescription of edoxaban (OR 0.83, 95%CI 0.71 – 0.96) were found to be associated with a reduced odds of non-adherence.

Conclusion(s): Almost one in fifteen patients with newly diagnosed AF were found to be non-adherent after one year of DOAC treatment. Understanding the predictors for non-adherence may help to identify patients at risk for undertreatment. Interventions to reinforce adherence could be specifically targeted at these patients, to reduce the risk of thromboembolic events.

Learning Objectives:

Upon completion, participant will be able to describe the one-year non-adherence rate in patients with atrial fibrillation newly prescribed a direct oral anticoagulant (DOAC)
Upon completion, participant will be able to list predictors for one-year non-adherence to DOACs and to identify patients with atrial fibrillation at risk for becoming non-adherent
Upon completion, participant will have a better understanding of the importance of discussing therapy adherence in the outpatient clinic