Abstract
Background Suboptimal adherence to direct oral anticoagulants (DOACs) among Atrial Fibrillation (AF) patients remains currently a major concern due to the increased risk of cardiac and thromboembolic events.
Aim The aim is to identify longitudinal distinct trajectories of DOAC adherence, and the sociodemographic and clinical factors associated with the trajectories.
Method Patients with AF who were prescribed a DOAC from July 2016 - December 2017 were identified among patients enrolled in Medicare Advantage Plan. Patients were followed up for a year after the index date to calculate the monthly Proportion of days covered (PDC). The monthly PDC was incorporated into the logistic GBTM to characterize the distinct patterns of adherence. A multinomial regression model was carried out to assess various predictors associated with each trajectory. Sub-group analysis was conducted among incident DOAC users.
Results A total of 1,969 patients with AF were included. Four distinct trajectories of adherence were selected: adherent (36.8%), gaps in adherence (9.3%), gradual decline in adherence (29.7%), and rapid decline in adherence (24.2%). Significant predictors associated with suboptimal adherence trajectories were age, gender, health plan, prevalent users, and the presence of comorbidities like hypertension, renal disease, and NSAID use. Among the 933 incident users, three adherence trajectories were identified: adherent trajectory (31.8%), rapid decline in adherence (32.5%), and gradual decline in adherence (35.6%). The significant factors identified among incident users were gender, health plan, HAS-BLED score, and coronary artery disease.
Conclusion Adherence to DOACs was suboptimal among the total population and the incident users.