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Adherence to oral anticoagulants among patients with atrial fibrillation: a systematic review and meta-analysis of observational studies

INTRODUCTION: Medications cannot exert their effect if not taken as prescribed by patients. Our objective was to summarise the observational evidence on adherence to oral anticoagulants (OACs) among patients with atrial fibrillation (AF). METHODS: In March 2019, we systematically searched PubMed/Med...

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Autores principales: Salmasi, Shahrzad, Loewen, Peter S, Tandun, Rachel, Andrade, Jason G, De Vera, Mary A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245382/
https://www.ncbi.nlm.nih.gov/pubmed/32273316
http://dx.doi.org/10.1136/bmjopen-2019-034778
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author Salmasi, Shahrzad
Loewen, Peter S
Tandun, Rachel
Andrade, Jason G
De Vera, Mary A
author_facet Salmasi, Shahrzad
Loewen, Peter S
Tandun, Rachel
Andrade, Jason G
De Vera, Mary A
author_sort Salmasi, Shahrzad
collection PubMed
description INTRODUCTION: Medications cannot exert their effect if not taken as prescribed by patients. Our objective was to summarise the observational evidence on adherence to oral anticoagulants (OACs) among patients with atrial fibrillation (AF). METHODS: In March 2019, we systematically searched PubMed/Medline, Embase, CINAHL and PsycINFO (from inception) for observational studies measuring adherence, its determinants and impacts in patients with AF. Mean adherence measures and corresponding proportions of adherent patients were pooled using random effects models. Factors shown to be independently associated with adherence were extracted as well as the clinical and economic outcomes of adherence. RESULTS: We included 30 studies. Pooled mean adherence scores of over half a million patients with AF 6 months and 1 year after therapy initiation were 77 (95% CI: 74–79) and 74 (68–79) out of 100, respectively. Drug-specific pooled mean adherence score at 6 months and 1 year were as follows: rivaroxaban: 78 (73–84) and 77 (69–86); apixaban: 77 (75–79) and 82 (74–89); dabigatran: 74 (69–79) and 75 (68–82), respectively. There was inadequate information on warfarin for inclusion in meta-analysis. Factors associated with increased adherence included: older age, higher stroke risk, once-daily regimen, history of hypertension, diabetes or stroke, concomitant cardiovascular medications, living in rural areas and being an experienced OAC user. Non-adherent patients were more likely to experience stroke and death, and incurred higher medical costs compared with patients with poor adherence. CONCLUSIONS: Our findings show that up to 30% of patients with AF are non-adherent, suggesting an important therapeutic challenge in this patient population.
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spelling pubmed-72453822020-06-03 Adherence to oral anticoagulants among patients with atrial fibrillation: a systematic review and meta-analysis of observational studies Salmasi, Shahrzad Loewen, Peter S Tandun, Rachel Andrade, Jason G De Vera, Mary A BMJ Open Cardiovascular Medicine INTRODUCTION: Medications cannot exert their effect if not taken as prescribed by patients. Our objective was to summarise the observational evidence on adherence to oral anticoagulants (OACs) among patients with atrial fibrillation (AF). METHODS: In March 2019, we systematically searched PubMed/Medline, Embase, CINAHL and PsycINFO (from inception) for observational studies measuring adherence, its determinants and impacts in patients with AF. Mean adherence measures and corresponding proportions of adherent patients were pooled using random effects models. Factors shown to be independently associated with adherence were extracted as well as the clinical and economic outcomes of adherence. RESULTS: We included 30 studies. Pooled mean adherence scores of over half a million patients with AF 6 months and 1 year after therapy initiation were 77 (95% CI: 74–79) and 74 (68–79) out of 100, respectively. Drug-specific pooled mean adherence score at 6 months and 1 year were as follows: rivaroxaban: 78 (73–84) and 77 (69–86); apixaban: 77 (75–79) and 82 (74–89); dabigatran: 74 (69–79) and 75 (68–82), respectively. There was inadequate information on warfarin for inclusion in meta-analysis. Factors associated with increased adherence included: older age, higher stroke risk, once-daily regimen, history of hypertension, diabetes or stroke, concomitant cardiovascular medications, living in rural areas and being an experienced OAC user. Non-adherent patients were more likely to experience stroke and death, and incurred higher medical costs compared with patients with poor adherence. CONCLUSIONS: Our findings show that up to 30% of patients with AF are non-adherent, suggesting an important therapeutic challenge in this patient population. BMJ Publishing Group 2020-04-08 /pmc/articles/PMC7245382/ /pubmed/32273316 http://dx.doi.org/10.1136/bmjopen-2019-034778 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Cardiovascular Medicine
Salmasi, Shahrzad
Loewen, Peter S
Tandun, Rachel
Andrade, Jason G
De Vera, Mary A
Adherence to oral anticoagulants among patients with atrial fibrillation: a systematic review and meta-analysis of observational studies
title Adherence to oral anticoagulants among patients with atrial fibrillation: a systematic review and meta-analysis of observational studies
title_full Adherence to oral anticoagulants among patients with atrial fibrillation: a systematic review and meta-analysis of observational studies
title_fullStr Adherence to oral anticoagulants among patients with atrial fibrillation: a systematic review and meta-analysis of observational studies
title_full_unstemmed Adherence to oral anticoagulants among patients with atrial fibrillation: a systematic review and meta-analysis of observational studies
title_short Adherence to oral anticoagulants among patients with atrial fibrillation: a systematic review and meta-analysis of observational studies
title_sort adherence to oral anticoagulants among patients with atrial fibrillation: a systematic review and meta-analysis of observational studies
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245382/
https://www.ncbi.nlm.nih.gov/pubmed/32273316
http://dx.doi.org/10.1136/bmjopen-2019-034778
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