Primary Nonadherence to Oral Anticoagulants in Patients with Atrial Fibrillation: Real-World Data from a Population-Based Cohort

Abstract

This work was partially supported by the 2013 Collaboration Agreement between the Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO) from the Valencia Ministry of Health and Boehringer Ingelheim, a nonconditioned program to conduct independent research in chronic health care, pharmacoepidemiology, and medical practice variation. Rodriguez-Bernal was funded by the Instituto de Salud Carlos III, Spanish Ministry of Health, and cofinanced by the European Regional Development Fund (grant number RD12/0001/0005). The views presented here are those of the authors and not necessarily those of the FISABIO Foundation, the Valencia Ministry of Health, or the study sponsors. The funding sources had no access to study data and did not participate in any way in the design or conduct of the study, data analysis, decisions regarding the dissemination of findings, the development of the manuscript, or its publication. Peiró has received fees for participation in scientific meetings and courses sponsored by Novartis and Ferrer International. In 2014, Sanfélix-Gimeno participated in an advisory meeting of Boehringer Ingelheim. García-Sempere is a former employee of Boehringer Ingelheim. Rodriguez-Bernal and Hurtado have no relationships relevant to the contents of this article to disclose. This work was previously submitted as an abstract (podium presentation) at the 31st International Society of Pharmacoepidemiology (ISPE) Annual Conference; August 22-26, 2015; Boston, Massachusetts.

Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study

“…Our findings are consistent with previous studies which have shown associations between polypharmacy12 30 and increased comorbidities25 and reduced risk of non-adherence or non-persistence for OACs and other cardiovascular medications. Understanding each of the multiple steps in the prescription-persistence cascade may aid design and implementation of better interventions to improve drug utilisation.…”

“…Observed rates of primary non-adherence for OAC are comparable with a recent Spanish study using large-scale regional EHR 12. Primary non-adherence varies across different drugs, but our estimates appear lower than other chronic disease medications (≤20.8% for lipid-lowering drugs23).…”

“…All DOACs have proven efficacy compared with VKA, although at much lower time in therapeutic range (TTR) in trials than usual clinical practice, but ‘head-to-head’ DOAC trial comparisons are unlikely. However, several studies have shown suboptimal adherence and persistence for DOACs in different countries and settings, even compared with VKA, and effective interventions are lacking 12–14. Underlying causes include factors at social, economic, health system, clinician and patient levels.…”

Current status and factors influencing oral anticoagulant therapy among patients with non-valvular atrial fibrillation in Jiangsu province, China: a multi-center, cross-sectional study

“…The relationship between old age and medication adherence has been as an issue in different studies [10,[21][22][23]. A population-based retrospective cohort study in Spain demonstrated that younger patients showed poorer primary adherence [22]. However, some studies concluded that old patients had poorer medication adherence [10,23], which is consistent with the results of this study.…”

“…The relationship between old age and medication adherence has been as an issue in different studies [10,[21][22][23]. A population-based retrospective cohort study in Spain demonstrated that younger patients showed poorer primary adherence [22].…”