The RElationship of Advanced Education and ADherence (ReAHEAD) on antithrombotic in younger patients with non-valvular atrial fibrillation in Taiwan

Chih-Sheng Chu¹, Cheng-Ting Tsai², Chun-Yao Huang³, Cheng-Hung Li⁴, Han-Lin Tsai⁵, Yen-Bin Liu⁶, Ju-Chi Liu⁷, Huai-Ren Chang⁸, Wei-Shiang Lin⁹, Tze-Fan Chao¹⁰, Tien-Ping Tsao¹¹, Jhih-Yuan Shih¹², Jun-Ted Chong¹³, Shih-Chung Huang¹⁴, Chih-Cheng Wu¹⁵, Cheng-Sheng Lin¹⁶, Chun-Che Shih¹⁷, Cheng-I Cheng¹⁸, Ting-Hsing Chao¹⁹, Cheng-Hung Chiang²⁰, Chi-Hung Huang²¹, Chen-Yu Chien²², Wei-Yu Lei²³, Keng-Ru Lin²⁴, Pao-Hsien Chu²⁵, Tsung-Hsien Lin²⁶

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan, ROC. Electronic address: chucs@kmu.edu.tw.
² Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104, Taiwan, ROC. Electronic address: chengtingtsai@gmail.com.
³ Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Medical University Hospital, No. 252, Wuxing St., Xinyi Dist., Taipei City, 110, Taiwan, ROC. Electronic address: cyhuang@tmu.edu.tw.
⁴ Cardiovascular Center, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Xitun Dist., Taichung City, 407, Taiwan, ROC. Electronic address: lichcil@yahoo.com.tw.
⁵ Division of Cardiology Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd., East Dist., Chiayi City, 600, Taiwan, ROC. Electronic address: thl.ks@msa.hinet.net.
⁶ Division of Cardiovascular Medicine, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan, ROC. Electronic address: yenbinliu@gmail.com.
⁷ Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe Dist., New Taipei City, 235, Taiwan, ROC; Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City, 110, Taiwan, ROC. Electronic address: liumdcv@tmu.edu.tw.
⁸ Division of Cardiovascular Medicine, Department of Internal medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Zhongyang Rd., Hualien City, Hualien County, 970, Taiwan, ROC. Electronic address: huairenchang@mail.tcu.edu.tw.
⁹ Division of Cardiovascular Medicine, Department of Internal Medicine, Tri-Service General Hospital, No. 325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City, 114, Taiwan, ROC. Electronic address: wslin545@ms27.hinet.net.
¹⁰ Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist., Taipei City, 112, Taiwan, ROC. Electronic address: eyckeyck@gmail.com.
¹¹ Division of Cardiovascular Medicine, Cheng Hsin General Hospital, No. 45, Zhenxing St., Beitou Dist., Taipei City, 112, Taiwan, ROC. Electronic address: 9206battery@gmail.com.
¹² Division of Cardiovascular Medicine, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan City, 710, Taiwan, ROC. Electronic address: s841027@gmail.com.
¹³ Division of Cardiovascular Medicine, Department of Internal Medicine, Pingtung Christian Hospital, No. 60, Dalian Rd., Pingtung City, Pingtung County, 900, Taiwan, ROC. Electronic address: dr_chong@hotmail.com.
¹⁴ Division of Cardiovascular Medicine, Department of Internal Medicine, Kuang Tien General Hospital, No. 117, Shatian Rd., Shalu Dist., Taichung City, 433, Taiwan, ROC. Electronic address: t0935167896@gmail.com.
¹⁵ Division of Cardiovascular Medicine, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Ln. 442, Sec. 1, Jingguo Rd., North Dist., Hsinchu City, 300, Taiwan, ROC. Electronic address: chihchengwumd@gmail.com.
¹⁶ Division of Cardiovascular Medicine, Tungs' Taichung Metro Harbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Wuqi Dist., Taichung City, 435, Taiwan, ROC. Electronic address: cs.lin328@msa.hinet.net.
¹⁷ Division of Cardiovascular Surgery, Department of Surgery, Taipei Municipal Wanfang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan, ROC. Electronic address: ccshih0603@tmu.edu.tw.
¹⁸ Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan, ROC. Electronic address: chris0921@cgmh.org.tw.
¹⁹ Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Shengli Rd., North Dist., Tainan City, 704, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Chung-Shan Medical University Hospital, School of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South Dist., Taichung City, 402, Taiwan, ROC. Electronic address: chaotinghsing@gmail.com.
²⁰ Division of Cardiovascular Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813, Taiwan, ROC. Electronic address: chenghungchiang@yahoo.com.tw.
²¹ Division of Cardiovascular Interventions, Cardiovascular Center, Cathay General Hospital, No. 280, Sec. 4, Ren'ai Rd., Da'an Dist., Taipei City, 106, Taiwan, ROC. Electronic address: hchbox@cgh.org.tw.
²² Division of Cardiovascular Medicine, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi County, 622, Taiwan, ROC. Electronic address: rightraintennis@gmail.com.
²³ Boehringer Ingelheim Taiwan Ltd, 12F., No. 2, Sec. 3, Minsheng E. Rd., Zhongshan Dist., Taipei City, 104, Taiwan, ROC. Electronic address: Vanessa.lei@boehringer-ingelheim.com.
²⁴ Boehringer Ingelheim Taiwan Ltd, 12F., No. 2, Sec. 3, Minsheng E. Rd., Zhongshan Dist., Taipei City, 104, Taiwan, ROC. Electronic address: alison.lin@boehringer-ingelheim.com.
²⁵ Division of Cardiovascular Medicine, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, ROC. Electronic address: taipei.chu@gmail.com.
²⁶ Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan, ROC. Electronic address: lth@kmu.edu.tw.

PMID: 41087222
DOI: 10.1016/j.jfma.2025.10.002

The RElationship of Advanced Education and ADherence (ReAHEAD) on antithrombotic in younger patients with non-valvular atrial fibrillation in Taiwan

Chih-Sheng Chu et al. J Formos Med Assoc. 2025.

. 2025 Oct 13:S0929-6646(25)00529-7.

doi: 10.1016/j.jfma.2025.10.002. Online ahead of print.

Authors

Affiliations

¹ Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan, ROC. Electronic address: chucs@kmu.edu.tw.
² Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., Taipei City, 104, Taiwan, ROC. Electronic address: chengtingtsai@gmail.com.
³ Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Medical University Hospital, No. 252, Wuxing St., Xinyi Dist., Taipei City, 110, Taiwan, ROC. Electronic address: cyhuang@tmu.edu.tw.
⁴ Cardiovascular Center, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Blvd., Xitun Dist., Taichung City, 407, Taiwan, ROC. Electronic address: lichcil@yahoo.com.tw.
⁵ Division of Cardiology Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd., East Dist., Chiayi City, 600, Taiwan, ROC. Electronic address: thl.ks@msa.hinet.net.
⁶ Division of Cardiovascular Medicine, Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan, ROC. Electronic address: yenbinliu@gmail.com.
⁷ Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe Dist., New Taipei City, 235, Taiwan, ROC; Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing St., Xinyi Dist., Taipei City, 110, Taiwan, ROC. Electronic address: liumdcv@tmu.edu.tw.
⁸ Division of Cardiovascular Medicine, Department of Internal medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Zhongyang Rd., Hualien City, Hualien County, 970, Taiwan, ROC. Electronic address: huairenchang@mail.tcu.edu.tw.
⁹ Division of Cardiovascular Medicine, Department of Internal Medicine, Tri-Service General Hospital, No. 325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City, 114, Taiwan, ROC. Electronic address: wslin545@ms27.hinet.net.
¹⁰ Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist., Taipei City, 112, Taiwan, ROC. Electronic address: eyckeyck@gmail.com.
¹¹ Division of Cardiovascular Medicine, Cheng Hsin General Hospital, No. 45, Zhenxing St., Beitou Dist., Taipei City, 112, Taiwan, ROC. Electronic address: 9206battery@gmail.com.
¹² Division of Cardiovascular Medicine, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Rd., Yongkang Dist., Tainan City, 710, Taiwan, ROC. Electronic address: s841027@gmail.com.
¹³ Division of Cardiovascular Medicine, Department of Internal Medicine, Pingtung Christian Hospital, No. 60, Dalian Rd., Pingtung City, Pingtung County, 900, Taiwan, ROC. Electronic address: dr_chong@hotmail.com.
¹⁴ Division of Cardiovascular Medicine, Department of Internal Medicine, Kuang Tien General Hospital, No. 117, Shatian Rd., Shalu Dist., Taichung City, 433, Taiwan, ROC. Electronic address: t0935167896@gmail.com.
¹⁵ Division of Cardiovascular Medicine, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, No. 25, Ln. 442, Sec. 1, Jingguo Rd., North Dist., Hsinchu City, 300, Taiwan, ROC. Electronic address: chihchengwumd@gmail.com.
¹⁶ Division of Cardiovascular Medicine, Tungs' Taichung Metro Harbor Hospital, No. 699, Sec. 8, Taiwan Blvd., Wuqi Dist., Taichung City, 435, Taiwan, ROC. Electronic address: cs.lin328@msa.hinet.net.
¹⁷ Division of Cardiovascular Surgery, Department of Surgery, Taipei Municipal Wanfang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan, ROC. Electronic address: ccshih0603@tmu.edu.tw.
¹⁸ Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, 833, Taiwan, ROC. Electronic address: chris0921@cgmh.org.tw.
¹⁹ Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Shengli Rd., North Dist., Tainan City, 704, Taiwan, ROC; Division of Cardiology, Department of Internal Medicine, Chung-Shan Medical University Hospital, School of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo N. Rd., South Dist., Taichung City, 402, Taiwan, ROC. Electronic address: chaotinghsing@gmail.com.
²⁰ Division of Cardiovascular Medicine, Department of Internal Medicine, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813, Taiwan, ROC. Electronic address: chenghungchiang@yahoo.com.tw.
²¹ Division of Cardiovascular Interventions, Cardiovascular Center, Cathay General Hospital, No. 280, Sec. 4, Ren'ai Rd., Da'an Dist., Taipei City, 106, Taiwan, ROC. Electronic address: hchbox@cgh.org.tw.
²² Division of Cardiovascular Medicine, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi County, 622, Taiwan, ROC. Electronic address: rightraintennis@gmail.com.
²³ Boehringer Ingelheim Taiwan Ltd, 12F., No. 2, Sec. 3, Minsheng E. Rd., Zhongshan Dist., Taipei City, 104, Taiwan, ROC. Electronic address: Vanessa.lei@boehringer-ingelheim.com.
²⁴ Boehringer Ingelheim Taiwan Ltd, 12F., No. 2, Sec. 3, Minsheng E. Rd., Zhongshan Dist., Taipei City, 104, Taiwan, ROC. Electronic address: alison.lin@boehringer-ingelheim.com.
²⁵ Division of Cardiovascular Medicine, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan, ROC. Electronic address: taipei.chu@gmail.com.
²⁶ Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Faculty of Medicine and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Ziyou 1st Rd., Sanmin Dist., Kaohsiung City, 807, Taiwan, ROC. Electronic address: lth@kmu.edu.tw.

PMID: 41087222
DOI: 10.1016/j.jfma.2025.10.002

Abstract

Background: The prevalence and incidence of non-valvular atrial fibrillation (NVAF) in Taiwan increase with age. Low adherence to oral anticoagulants heightens stroke risk. This study evaluated whether advanced educational intervention could enhance dabigatran adherence in Taiwanese patients with NVAF.

Methods: This multicenter clinical trial in Taiwan enrolled 873 patients aged 20-74 years and newly diagnosed with NVAF. Patients were randomized to receive advanced educational intervention or standard care only. Dabigatran adherence at 12 months was evaluated using the Morisky Medication Adherence Scale (MMAS-8), along with the proportion of subjects reporting "never/rarely forgetting to take dabigatran" at 3, 6, and 9 months, dabigatran discontinuation rate, and the safety outcomes in both groups.

Results: Both groups reached the maximum MMAS-8 median score at all visits, showing no significant differences. Adverse event rates were 3.9 % (17/441) in the standard care group, including four stroke and thromboembolic events, versus 4.2 % (18/432) in the advanced educational intervention group, with one stroke and thromboembolic event. Subgroup analysis of patients with initial MMAS-8 scores below 8 points showed a significant difference at sixth month (6 vs. 7, P = 0.011). Over 3, 6, 9, and 12 months, MMAS-8 scores improved in both groups, with the advanced educational intervention group achieving a perfect adherence by 12 months (routine group: 6, 6, 7, 7; advanced group: 6, 7, 7, 8).

Conclusion: Advanced educational intervention significantly improved dabigatran adherence in younger patients with low initial adherence, demonstrating its potential in managing NVAF in Taiwan.

Trial registration number: NCT04532528.

Keywords: Atrial fibrillation; Dabigatran; Health education; Patient adherence.

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Conflict of interest statement

Declaration of competing interest W.-Y. L. and K.-R. L. are employees of Boehringer Ingelheim. All other authors indicate that they have nothing to declare. The authors did not receive payment related to the development of the manuscript.

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The RElationship of Advanced Education and ADherence (ReAHEAD) on antithrombotic in younger patients with non-valvular atrial fibrillation in Taiwan

Affiliations

The RElationship of Advanced Education and ADherence (ReAHEAD) on antithrombotic in younger patients with non-valvular atrial fibrillation in Taiwan

Authors

Affiliations

Abstract

Conflict of interest statement

Associated data

LinkOut - more resources

Full Text Sources