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. 2017 Sep 2;17(1):236.
doi: 10.1186/s12872-017-0671-6.

Adherence and outcomes to direct oral anticoagulants among patients with atrial fibrillation: findings from the veterans health administration

Ryan T Borne  1 , Colin O'Donnell  2 , Mintu P Turakhia  3   4 , Paul D Varosy  5   2 , Cynthia A Jackevicius  6 , Lucas N Marzec  5 , Frederick A Masoudi  5 , Paul L Hess  5   2 , Thomas M Maddox  7 , P Michael Ho  5   2
Affiliations

Adherence and outcomes to direct oral anticoagulants among patients with atrial fibrillation: findings from the veterans health administration

Ryan T Borne et al. BMC Cardiovasc Disord. .

Abstract

Background: The direct oral anticoagulants (DOACs) reduce the risk of stroke in moderate to high-risk patients with non-valvular atrial fibrillation (AF). Yet, concerns remain regarding its routine use in real world practice. We sought to describe adherence patterns and the association between adherence and outcomes to the DOACs among outpatients with AF.

Methods: We performed a retrospective cohort study of patients in the VA Healthcare System who initiated pharmacotherapy with dabigatran, rivaroxaban, or apixaban between November 2010 and January 2015 for non-valvular AF with CHA2DS2-VASc score ≥ 2. Adherence was determined using pharmacy refill data and estimated by the proportion of days covered (PDC) over the first year of therapy. Clinical outcomes, including all-cause mortality and stroke, were measured at 6 months and used to assess measures of adherence for each DOAC.

Results: A total of 2882 patients were included. Most were prescribed dabigatran (72.7%), compared with rivaroxaban (19.8%) or apixaban (7.5%). The mean PDC was 0.84 ± 0.20 for dabigatran, 0.86 ± 0.18 for rivaroxaban, and 0.89 ± 0.14 for apixaban (p < 0.01). The proportion of non-adherent patients, PDC <0.80, was 27.6% for all and varied according DOAC. Lower adherence to dabigatran was associated with higher risk of mortality and stroke (HR 1.07; 1.03-1.12 per 0.10 decline in PDC).

Conclusions: In a real-world VA population being prescribed anticoagulation for AF, more than one quarter had sub-optimal adherence. Lower adherence was associated with a higher risk of mortality and stroke. Efforts identifying non-adherent patients, and targeted adherence interventions are needed to improve outcomes.

Keywords: Atrial fibrillation; Direct oral anticoagulants; Medication adherence.

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Conflict of interest statement

Ethics approval and consent to participate

This study received approval from the Colorado Multiple Institutional Review Board (IRB 12–0347).

Consent for publication

Not applicable.

Competing interests

PMH is the deputy editor of Circulation: Cardiovascular Quality and Outcomes journal and serves in the steering committee for Janssen, Inc. trial t6o improve adherence to DOACs. There are otherwise no conflicts for all other others pertaining to the work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow Diagram of patient inclusion and exclusion
See this image and copyright information in PMC

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