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Assessing Adherence and Persistence to Non-vitamin K Antagonist Oral Anticoagulants (NOACs) among Patients with Atrial Fibrillation in Tertiary-care Referral Centers in Malaysia

INTRODUCTION: Non-vitamin K antagonist oral anticoagulants (NOACs), such as dabigatran and rivaroxaban, are now available for stroke prevention in patients with atrial fibrillation (AF) and are often clinically preferred over vitamin K antagonists (VKAs), such as warfarin. Data describing adherence...

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Autores principales: Kubas, Mohammed A, Shabaruddin, Fatiha Hana, Mazlan-Kepli, Wardati, Jagan, Nirmala, Mohamed, Sahimi, Mohamed Nazar, Nor Ilyani, Zin, Che Suraya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021046/
https://www.ncbi.nlm.nih.gov/pubmed/33828378
http://dx.doi.org/10.4103/jpbs.JPBS_381_19
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author Kubas, Mohammed A
Shabaruddin, Fatiha Hana
Mazlan-Kepli, Wardati
Jagan, Nirmala
Mohamed, Sahimi
Mohamed Nazar, Nor Ilyani
Zin, Che Suraya
author_facet Kubas, Mohammed A
Shabaruddin, Fatiha Hana
Mazlan-Kepli, Wardati
Jagan, Nirmala
Mohamed, Sahimi
Mohamed Nazar, Nor Ilyani
Zin, Che Suraya
author_sort Kubas, Mohammed A
collection PubMed
description INTRODUCTION: Non-vitamin K antagonist oral anticoagulants (NOACs), such as dabigatran and rivaroxaban, are now available for stroke prevention in patients with atrial fibrillation (AF) and are often clinically preferred over vitamin K antagonists (VKAs), such as warfarin. Data describing adherence and persistence to NOACs in real-life clinical practice in Malaysia are scarce. This study aimed to assess adherence and persistence to NOACs in patients with AF in two tertiary-care referral centers: Hospital Kuala Lumpur (HKL) and Hospital Serdang (HSDG). MATERIALS AND METHODS: This was a retrospective cohort study that included all patients with AF who were treated with NOACs (dabigatran or rivaroxaban) in HKL and HSDG. Data were obtained from medical records and pharmacy databases. Adherence was assessed using proportion of days covered (PDC) over a 1-year duration. High adherence was defined as PDC ≥80%. A gap of >60 days between two consecutive refills was used to define non-persistence. RESULT: There were 281 patients who met the inclusion criteria, with 54.1% (n = 152) male. There were 75.1% (n = 211) patients on dabigatran and others on rivaroxaban. Only 66.9% (n = 188) of patients achieved high adherence with PDC ≥80% and 69.8% (n = 196) were persistence with >60-day gap over 12 months. Adherence and persistence were both influenced by treatment center, whereas polypharmacy only influenced adherence. CONCLUSION: Overall adherence and persistence to NOACs were suboptimal and varied between treatment centers, potentially due to institution-specific administrative and clinical practice differences. Clinical care and outcomes can potentially be optimized by identifying factors affecting adherence and persistence and by implementing interventions to improving them.
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spelling pubmed-80210462021-04-06 Assessing Adherence and Persistence to Non-vitamin K Antagonist Oral Anticoagulants (NOACs) among Patients with Atrial Fibrillation in Tertiary-care Referral Centers in Malaysia Kubas, Mohammed A Shabaruddin, Fatiha Hana Mazlan-Kepli, Wardati Jagan, Nirmala Mohamed, Sahimi Mohamed Nazar, Nor Ilyani Zin, Che Suraya J Pharm Bioallied Sci Original Article INTRODUCTION: Non-vitamin K antagonist oral anticoagulants (NOACs), such as dabigatran and rivaroxaban, are now available for stroke prevention in patients with atrial fibrillation (AF) and are often clinically preferred over vitamin K antagonists (VKAs), such as warfarin. Data describing adherence and persistence to NOACs in real-life clinical practice in Malaysia are scarce. This study aimed to assess adherence and persistence to NOACs in patients with AF in two tertiary-care referral centers: Hospital Kuala Lumpur (HKL) and Hospital Serdang (HSDG). MATERIALS AND METHODS: This was a retrospective cohort study that included all patients with AF who were treated with NOACs (dabigatran or rivaroxaban) in HKL and HSDG. Data were obtained from medical records and pharmacy databases. Adherence was assessed using proportion of days covered (PDC) over a 1-year duration. High adherence was defined as PDC ≥80%. A gap of >60 days between two consecutive refills was used to define non-persistence. RESULT: There were 281 patients who met the inclusion criteria, with 54.1% (n = 152) male. There were 75.1% (n = 211) patients on dabigatran and others on rivaroxaban. Only 66.9% (n = 188) of patients achieved high adherence with PDC ≥80% and 69.8% (n = 196) were persistence with >60-day gap over 12 months. Adherence and persistence were both influenced by treatment center, whereas polypharmacy only influenced adherence. CONCLUSION: Overall adherence and persistence to NOACs were suboptimal and varied between treatment centers, potentially due to institution-specific administrative and clinical practice differences. Clinical care and outcomes can potentially be optimized by identifying factors affecting adherence and persistence and by implementing interventions to improving them. Wolters Kluwer - Medknow 2020-11 2020-11-05 /pmc/articles/PMC8021046/ /pubmed/33828378 http://dx.doi.org/10.4103/jpbs.JPBS_381_19 Text en Copyright: © 2020 Journal of Pharmacy and Bioallied Sciences http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Kubas, Mohammed A
Shabaruddin, Fatiha Hana
Mazlan-Kepli, Wardati
Jagan, Nirmala
Mohamed, Sahimi
Mohamed Nazar, Nor Ilyani
Zin, Che Suraya
Assessing Adherence and Persistence to Non-vitamin K Antagonist Oral Anticoagulants (NOACs) among Patients with Atrial Fibrillation in Tertiary-care Referral Centers in Malaysia
title Assessing Adherence and Persistence to Non-vitamin K Antagonist Oral Anticoagulants (NOACs) among Patients with Atrial Fibrillation in Tertiary-care Referral Centers in Malaysia
title_full Assessing Adherence and Persistence to Non-vitamin K Antagonist Oral Anticoagulants (NOACs) among Patients with Atrial Fibrillation in Tertiary-care Referral Centers in Malaysia
title_fullStr Assessing Adherence and Persistence to Non-vitamin K Antagonist Oral Anticoagulants (NOACs) among Patients with Atrial Fibrillation in Tertiary-care Referral Centers in Malaysia
title_full_unstemmed Assessing Adherence and Persistence to Non-vitamin K Antagonist Oral Anticoagulants (NOACs) among Patients with Atrial Fibrillation in Tertiary-care Referral Centers in Malaysia
title_short Assessing Adherence and Persistence to Non-vitamin K Antagonist Oral Anticoagulants (NOACs) among Patients with Atrial Fibrillation in Tertiary-care Referral Centers in Malaysia
title_sort assessing adherence and persistence to non-vitamin k antagonist oral anticoagulants (noacs) among patients with atrial fibrillation in tertiary-care referral centers in malaysia
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021046/
https://www.ncbi.nlm.nih.gov/pubmed/33828378
http://dx.doi.org/10.4103/jpbs.JPBS_381_19
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