IntroductionEffectiveness of oral anticoagulants (OACs) is critically dependent on patients’ adherence to intake regimens. We studied the relative impact of attributes related to effectiveness, safety, convenience, and costs on the value of OAC therapy from the perspective of patients with non-valvular atrial fibrillation.MethodsFour attributes were identified by literature review and expert interviews: effectiveness (risk of ischemic stroke), safety (risk of major bleeding, minor bleeding, gastrointestinal complaints), convenience (intake frequency, diet restrictions, international normalized ratio [INR] blood monitoring, pill type/intake instructions), and out-of-pocket costs. Focus groups were held in Spain, Germany, France, Italy and the United Kingdom (N = 48) to elicit patients’ preferences through the use of the analytical hierarchy process method.ResultsEffectiveness (60%) and side effects (27%) have a higher impact on the perceived value of OACs than drug convenience (7%) and out-of-pocket costs (6%). As for convenience, eliminating monthly INR monitoring was given the highest priority (40%), followed by reducing diet restrictions (27%), reducing intake frequency (17%) and improving the pill type/intake instructions (15%). The most important side effect was major bleeding (75%), followed by minor bleeding (15%) and gastrointestinal complaints (10%). Furthermore, 71% of patients preferred once-daily intake to twice-daily intake.DiscussionAlthough the relative impact of convenience on therapy value is small, patients have different preferences for options within convenience criteria. Besides considerations on safety and effectiveness, physicians should also discuss attributes of convenience with patients, as it can be assumed that alignment to patient preferences in drug prescription and better patient education could result in higher adherence.Electronic supplementary materialThe online version of this article (10.1007/s40256-018-0293-0) contains supplementary material, which is available to authorized users.

OAT adherence can be promoted if therapies are tailored to patients' needs and preferences. Patients should be supported to share their preferences with their clinician.

ObjectivesTo examine patients’ perspectives regarding composite endpoints and the utility patients put on possible adverse outcomes of revascularization procedures.DesignIn the PRECORE study, a stated preference elicitation method Best‐Worst Scaling (BWS) was used to determine patient preference for 8 component endpoints (CEs): need for redo percutaneous coronary intervention (PCI) within 1 year, minor stroke with symptoms <24 hours, minor myocardial infarction (MI) with symptoms <3 months, recurrent angina pectoris, need for redo coronary artery bypass grafting (CABG) within 1 year, major MI causing permanent disability, major stroke causing permanent disability and death within 24 hours.SettingA tertiary PCI/CABG centre.ParticipantsOne hundred and sixty patients with coronary artery disease who underwent PCI or CABG.Main outcome measuresImportance weights (IWs).ResultsPatients considered need for redo PCI within 1 year (IW: 0.008), minor stroke with symptoms <24 hours (IW: 0.017), minor MI with symptoms <3 months (IW: 0.027), need for redo CABG within 1 year (IW: 0.119), recurrent angina pectoris (IW: 0.300) and major MI causing permanent disability (IW: 0.726) less severe than death within 24 hours (IW: 1.000). Major stroke causing permanent disability was considered worse than death within 24 hours (IW: 1.209). Ranking of CEs and the relative values attributed to the CEs differed among subgroups based on gender, age and educational level.ConclusionPatients attribute different weight to individual CEs. This has significant implications for the interpretation of clinical trial data.

depression were matched (1:1) to the hypertension cases with depression based on age, gender, physician, and initial antihypertensive therapy, using a propensity score method. The main outcome of the study was the rate of persistence with antihypertensive drugs in individuals with hypertension with and without depression in the 12 months following the index date. Persistence was estimated as therapy duration without treatment disruption, which was defined as at least three months without oral antihyperglycemic drugs. The effect of depression on persistence with antihypertensive treatment was analyzed in the entire population and in various subgroups using Cox regression models. Results: The study included 24,627 hypertension patients with depression and 24,627 hypertension patients without depression. The mean age was 59.7 years (SD= 12.1 years), and 37.3% were men. After 12 months of follow-up, the rate of persistence with antihypertensive therapy was 64.5% in individuals with depression and 66.9% in individuals without depression (p-value= 0.232). Depression was found to have no significant impact on discontinuation in the overall population (HR= 1.01, 95% CI: 0.99-1.03) or in the different subgroups (HRs ranging from 0.93 to 1.03). ConClusions: Depression was not significantly associated with persistence with antihypertensive drugs in Germany.

13.9% of all patients). Apixaban, dabigatran and rivaroxaban were underdosed in 14.2% of the reduced dose prescriptions and overdosed in 4.5% of the full dose prescriptions. CONCLUSIONS: This study provides real-world evidence that underdosing of NOACs occurs more often than overdosing. Crucial patient-specific information to determine the correct dose is often lacking. Periodic populationbased monitoring of anticoagulant prescriptions can help to achieve vigilance in stroke prevention with NOACs along the years.