Oral anticoagulant adherence and switching in patients with atrial fibrillation: A prospective observational study |
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| Affiliation: | 1. Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, BC, Canada;2. Faculty of Pharmaceutical Sciences, University of British Columbia, Canada;3. Data Analytics, Statistics and Informatics, Faculty of Pharmaceutical Sciences, University of British Columbia, Canada;4. Atrial Fibrillation Clinic, Royal Columbian Hospital, New Westminster, Canada;5. Atrial Fibrillation Clinic, Vancouver General Hospital, Vancouver, Canada;6. Division of Cardiology, Faculty of Medicine, The University of British Columbia, Canada;7. UBC Centre for Cardiovascular Innovation, Vancouver, Canada;8. Atrial Fibrillation Clinic, St. Paul''s Hospital, Vancouver, Canada;1. University of Wisconsin School of Pharmacy, Social & Administrative Sciences Division, Madison, WI, USA;2. University of Wisconsin School of Nursing, Madison, WI, USA;1. North Dakota State University School of Pharmacy, 1401 Albrecht Boulevard, Fargo, ND, 58108, USA;2. Ohio Northern University Raabe College of Pharmacy, 525 S. Main St, Ada, OH, 45810, USA;3. Ferris State University College of Pharmacy, 220 Ferris Dr, Big Rapids, MI, 49307, USA;4. Cedarville University School of Pharmacy, 251 N. Main St, Cedarville, OH, 45314, USA;1. School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia;2. Sekolah Tinggi Ilmu Kesehatan ISFI Banjarmasin, Jl. Flamboyan III No.7C, Banjarmasin, Kalimantan Selatan, 70123, Indonesia;3. Faculty of Medicine, Universitas Wijaya Kusuma Surabaya, Jalan Dukuh Kupang XXV/54, Surabaya, 60225, Indonesia;4. Faculty of Pharmacy, Universitas Jember, Jalan Kalimantan I No. 2, Sumbersari, Jember, 68121, Indonesia;5. School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, N517, Pharmacy and Bank Building A15, NSW, 2006, Australia;1. The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, NSW, Australia;2. NSW Poisons Information Centre, The Children''s Hospital at Westmead, Sydney, Australia;3. Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia;4. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia;5. Aging Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden |
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| Abstract: | BackgroundAdherence to oral anticoagulants (OACs) in patients with atrial fibrillation (AF) is important in preventing stroke. The dominance of retrospective studies using administrative data has led to a lack of data on psychosocial determinants of adherence and prevented comparison of adherence between OAC drug classes. OAC switching is another aspect of adherence that is unexplored.MethodsA prospective design was utilized to measure AF patients’ self-reported adherence and OAC switching, and to identify their clinical, demographic, and psychosocial determinants. Participants were recruited from specialized AF clinics in Canada and followed for up to 2 years. Data were collected via telephone every 3–4 months using a structured survey. Adherence was measured using the Morisky Medication Adherence scale (©MMAS-8).ResultsThe included participants (N = 306) were followed for a median follow up time of 14.1 months and had an average of 3.2(SD 1.4) study visits. The mean self-reported adherence on the ©MMAS-8 was 7.28(SD 0.71) for patients receiving care at specialized AF clinics. Older age, experiencing a bleed, and higher satisfaction with the burden of medications were significantly associated with higher adherence. Drug class did not have any significant impact on adherence. 7.8% of the cohort experienced a switch with most of them being from warfarin to DOAC. Taking warfarin as the index medication, experiencing a bleed and older age were significantly associated with higher odds of switching.ConclusionPatients with AF reported high adherence to their OAC therapy however being on DOAC may not translate to better adherence compared to VKA. Improving satisfaction with the burden of therapy is important in improving adherence. |
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| Keywords: | Adherence Persistence Anticoagulants Atrial fibrillation Stroke prevention Switch |
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