Long-term persistence and adherence with non-vitamin K oral anticoagulants in patients with atrial fibrillation and their associations with stroke risk
Open Access
- 9 April 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal - Cardiovascular Pharmacotherapy
- Vol. 7 (FI1), f72-f80
- https://doi.org/10.1093/ehjcvp/pvaa017
Abstract
Studies on adherence and persistence with non-vitamin K oral anticoagulant (NOAC) treatment have relied on data from the early years of NOAC availability. We aimed to study long-term adherence and persistence with NOACs and their association with stroke risk. From the Stockholm Healthcare database, we included 21 028 atrial fibrillation patients claiming a first NOAC prescription from July 2011 until October 2018, with more than 1000 patients having more than 5 years of follow-up (median: 2.0, interquartile range: 1.0–3.2). Persistence rates, defined as continuing to claim NOAC prescriptions within a 90-day gap, decreased to 70% at the end of follow-up. However, 85% of the patients were treated at the end of the study due to reinitiations. Adherence, calculated as medication possession rate (MPR) in 3 and 6-month intervals among persistent users, remained stable at 90%, with 75% of patients having an MPR >95% throughout the study period. Using a case–control design, we calculated associations of persistence and adherence with stroke risk, adjusting for potential confounders. The outcome was a composite of ischaemic or unspecified stroke and transient ischaemic attack. Non-persistence and poor adherence were both associated with increased stroke risk [non-persistence adjusted odds ratio (aOR): 2.05; 95% confidence interval (CI): 1.49–2.82, 1% reduction MPR aOR: 1.03; CI: 1.01–1.05]. There was no association between non-persistence or poor adherence and the falsification endpoints; fractions and respiratory infections, indicating no ‘healthy-adherer’ effect. Persistence rates decreased slowly over time, but persistent patients had high adherence rates. Both non-persistence and poor adherence were associated with an increased stroke risk.Keywords
Funding Information
- Regional Ethical Review Board in Stockholm (EPN 2015/579-31/2)
- Swedish Heart Lung Foundation
- Stockholm County Council
This publication has 27 references indexed in Scilit:
- Adherence to oral anticoagulant therapy in patients with atrial fibrillationThrombosis and Haemostasis, 2017
- Proposal of Standardization to Assess Adherence With Medication RecordsAnnals of Pharmacotherapy, 2016
- Effect of Adherence to Oral Anticoagulants on Risk of Stroke and Major Bleeding Among Patients With Atrial FibrillationJournal of the American Heart Association, 2016
- Comparison of treatment persistence with different oral anticoagulants in patients with atrial fibrillationEuropean Journal of Clinical Pharmacology, 2015
- Adherence to dabigatran therapy and longitudinal patient outcomes: Insights from the Veterans Health AdministrationAmerican Heart Journal, 2014
- Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trialsThe Lancet, 2014
- Risk scoring and thromboprophylactic treatment of patients with atrial fibrillation with and without access to primary healthcare data: Experience from the Stockholm health care systemInternational Journal of Cardiology, 2013
- Prespecified Falsification End PointsJAMA, 2013
- The new Swedish Prescribed Drug Register—Opportunities for pharmacoepidemiological research and experience from the first six monthsPharmacoepidemiology and Drug Safety, 2006
- Adherence to MedicationThe New England Journal of Medicine, 2005