Adherence with direct oral anticoagulants in nonvalvular atrial fibrillation new users and associated factors: a French nationwide cohort study

Abstract

PurposeDirect oral anticoagulants (DOACs) have been promoted in patients with nonvalvular atrial fibrillation (nv‐AF) as a more convenient alternative to vitamin K antagonists. We estimated 1‐year dabigatran and rivaroxaban adherence rates in nv‐AF patients and assessed associations between baseline patient characteristics and nonadherence.MethodsThis cohort study included OAC‐naive nv‐AF patients with no contraindications to OAC, who initiated dabigatran and rivaroxaban, using nationwide data from French national health care databases. One‐year adherence was defined by the proportion of days covered of 80% or more over a fixed 1‐year period after treatment initiation. Associations between nonadherence and baseline patient characteristics were assessed using multivariate logistic regression models.ResultsThe population was composed of 11 141 dabigatran (women: 48%; mean age: 74 ± 10.7 y; ≥80 y: 34.9%) and 11 126 rivaroxaban (46.5%; 74 ± 10.9 y; 34.8%) new users. One‐year adherence was 53.3% in dabigatran‐treated and 59.9% in rivaroxaban‐treated patients, consistent with numerous subgroup analyses. A switch to vitamin K antagonist was observed in 14.5% of dabigatran and 11.7% of rivaroxaban patients; 10.2% and 5.9% of patients switched to another DOAC, respectively; and 4.3% of patients died in the 2 cohorts. In patients who did not die or switch during the follow‐up, 1‐year adherence was 69.6% in dabigatran‐treated and 72.3% in rivaroxaban‐treated patients. Having concomitant ischemic heart diseases was associated with an increased risk of nonadherence in the 2 cohorts.ConclusionIn this real‐life study, 1‐year adherence to DOAC is poor in nv‐AF new users. Despite the introduction of DOAC, adherence to OACs may remain a significant challenge in AF patients.

Incidence of direct oral anticoagulant use in patients with nonvalvular atrial fibrillation and characteristics of users in 6 European countries (2008–2015): A cross‐national drug utilization study

“…The mean age of our study population reflected other European studies on users of DOAC with NVAF, despite varying inclusion criteria . In line with other studies, we found that most of the users were older than 75 years, except in Mondriaan and DNR databases …”

“…A higher proportion of males was observed in all except the German databases, similarly to other published studies . The larger proportion of women in the German databases could be related to the characteristics of the population or to differences in NVAF incidence.…”

“…The concomitant use of cardiovascular drugs has been reported in some studies, in particular antiplatelet drugs, between 11 and 30% of users; similarly, antiplatelet drugs were used in 10–18% of the DOAC users in several databases in our study. Amiodarone, a strong P‐glycoprotein inhibitor, was the most frequent potentially interacting drug in several databases.…”

“…To our knowledge this is the first cross‐national drug utilization study providing the incidence of DOAC use in NVAF patients at a national/regional level, across several European countries. Only a few, single country European studies with similar inclusion criteria have been published, which only provide number of DOAC users rather than incidence figures …”

“…Clinical trials have shown that both vitamin K antagonists and DOACs reduce stroke and mortality in AF patients . Utilization of DOACs for stroke prevention in NVAF and their effectiveness and safety in clinical practice have been assessed in several European countries . However, little is known about their use beyond clinical trial conditions, especially in patients with hepatic or renal impairment.…”