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Adherence to direct oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study

BACKGROUND: Adherence to direct oral anticoagulants (DOACs) in patients with atrial fibrillation in every day practice may be less than in clinical trials. AIMS: To assess adherence to DOACs in atrial fibrillation patients in every day practice and identify predictors for non‐adherence. METHODS: Ind...

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Autores principales: Zielinski, Gilda D., van Rein, Nienke, Teichert, Martina, Klok, Frederikus A., Rosendaal, Frits R., van der Meer, Felix J. M., Huisman, Menno V., Cannegieter, Suzanne C., Lijfering, Willem M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8360064/
https://www.ncbi.nlm.nih.gov/pubmed/33822401
http://dx.doi.org/10.1002/pds.5242
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author Zielinski, Gilda D.
van Rein, Nienke
Teichert, Martina
Klok, Frederikus A.
Rosendaal, Frits R.
van der Meer, Felix J. M.
Huisman, Menno V.
Cannegieter, Suzanne C.
Lijfering, Willem M.
author_facet Zielinski, Gilda D.
van Rein, Nienke
Teichert, Martina
Klok, Frederikus A.
Rosendaal, Frits R.
van der Meer, Felix J. M.
Huisman, Menno V.
Cannegieter, Suzanne C.
Lijfering, Willem M.
author_sort Zielinski, Gilda D.
collection PubMed
description BACKGROUND: Adherence to direct oral anticoagulants (DOACs) in patients with atrial fibrillation in every day practice may be less than in clinical trials. AIMS: To assess adherence to DOACs in atrial fibrillation patients in every day practice and identify predictors for non‐adherence. METHODS: Individual linked dispensing data of atrial fibrillation patients who used DOACs were obtained from the Foundation for Pharmaceutical Statistics covering the Netherlands between 2012 and 2016. One year adherence to DOAC was calculated for initial DOAC as proportion of days covered (PDC) ≥80% and the association between clinical variables and adherence was assessed using logistic regression. In addition, we measured non‐persistence, that is, patients who completely stopped their initial DOAC within 1 year follow‐up. RESULTS: A total of 4797 apixaban‐, 20 454 rivaroxaban‐ and 18 477 dabigatran users were included. The mean age was 69 years (n = 43 910), which was similar for the DOAC types. The overall proportion of patients with PDC ≥80% was 76%, which was highest for apixaban‐ (87%), followed by dabigatran‐ (80%) and rivaroxaban (69%) users. Multivariable analyses revealed that age ≤60 years, no concomitant drug use were predictors for non‐adherence. Of atrial fibrillation patients who continued treatment, 97% had a PDC ≥80%, compared with only 56% for those who discontinued their DOAC treatment within 1 year. CONCLUSIONS: Non‐adherence to DOACs was associated with age ≤60 years and no concomitant drugs use. Non‐adherence was higher in patients who later discontinued DOAC treatment. Results of our study support research into interventions to improve adherence.
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spelling pubmed-83600642021-08-17 Adherence to direct oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study Zielinski, Gilda D. van Rein, Nienke Teichert, Martina Klok, Frederikus A. Rosendaal, Frits R. van der Meer, Felix J. M. Huisman, Menno V. Cannegieter, Suzanne C. Lijfering, Willem M. Pharmacoepidemiol Drug Saf Original Articles BACKGROUND: Adherence to direct oral anticoagulants (DOACs) in patients with atrial fibrillation in every day practice may be less than in clinical trials. AIMS: To assess adherence to DOACs in atrial fibrillation patients in every day practice and identify predictors for non‐adherence. METHODS: Individual linked dispensing data of atrial fibrillation patients who used DOACs were obtained from the Foundation for Pharmaceutical Statistics covering the Netherlands between 2012 and 2016. One year adherence to DOAC was calculated for initial DOAC as proportion of days covered (PDC) ≥80% and the association between clinical variables and adherence was assessed using logistic regression. In addition, we measured non‐persistence, that is, patients who completely stopped their initial DOAC within 1 year follow‐up. RESULTS: A total of 4797 apixaban‐, 20 454 rivaroxaban‐ and 18 477 dabigatran users were included. The mean age was 69 years (n = 43 910), which was similar for the DOAC types. The overall proportion of patients with PDC ≥80% was 76%, which was highest for apixaban‐ (87%), followed by dabigatran‐ (80%) and rivaroxaban (69%) users. Multivariable analyses revealed that age ≤60 years, no concomitant drug use were predictors for non‐adherence. Of atrial fibrillation patients who continued treatment, 97% had a PDC ≥80%, compared with only 56% for those who discontinued their DOAC treatment within 1 year. CONCLUSIONS: Non‐adherence to DOACs was associated with age ≤60 years and no concomitant drugs use. Non‐adherence was higher in patients who later discontinued DOAC treatment. Results of our study support research into interventions to improve adherence. John Wiley & Sons, Inc. 2021-05-04 2021-08 /pmc/articles/PMC8360064/ /pubmed/33822401 http://dx.doi.org/10.1002/pds.5242 Text en © 2021 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Zielinski, Gilda D.
van Rein, Nienke
Teichert, Martina
Klok, Frederikus A.
Rosendaal, Frits R.
van der Meer, Felix J. M.
Huisman, Menno V.
Cannegieter, Suzanne C.
Lijfering, Willem M.
Adherence to direct oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study
title Adherence to direct oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study
title_full Adherence to direct oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study
title_fullStr Adherence to direct oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study
title_full_unstemmed Adherence to direct oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study
title_short Adherence to direct oral anticoagulant treatment for atrial fibrillation in the Netherlands: A surveillance study
title_sort adherence to direct oral anticoagulant treatment for atrial fibrillation in the netherlands: a surveillance study
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8360064/
https://www.ncbi.nlm.nih.gov/pubmed/33822401
http://dx.doi.org/10.1002/pds.5242
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