Persistence and adherence to non-vitamin K antagonist oral anticoagulant treatment in patients with atrial fibrillation across five Western European countries

Author:

Komen Joris J12ORCID,Pottegård Anton3,Mantel-Teeuwisse Aukje K1,Forslund Tomas24ORCID,Hjemdahl Paul4ORCID,Wettermark Björn5,Hellfritzsch Maja36,Hallas Jesper3ORCID,Olesen Morten3,Bennie Marion78,Mueller Tanja7,Voss Annemarie9,Schink Tania9,Haug Ulrike910,Kollhorst Bianca11,Karlstad Øystein12,Kjerpeseth Lars J12,Klungel Olaf H13

Affiliation:

1. Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands

2. Department of Healthcare Development, Stockholm Region, Public Healthcare Services Committee, Stockholm, Sweden

3. Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark

4. Department of Medicine Solna, Clinical Epidemiology/Clinical Pharmacology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden

5. Department of Pharmacy, Pharmacoepidemiology & Social Pharmacy, Uppsala University, Uppsala, Sweden

6. Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark

7. Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK

8. Public Health and Intelligence Strategic Business Unit, NHS National Services Scotland, Glasgow, UK

9. Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany

10. Faculty of Human and Life Sciences, University of Bremen, Bremen, Germany

11. Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany

12. Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway

Abstract

Abstract Aims To assess persistence and adherence to non-vitamin K antagonist oral anticoagulant (NOAC) treatment in patients with atrial fibrillation (AF) in five Western European healthcare settings. Methods and results We conducted a multi-country observational cohort study, including 559 445 AF patients initiating NOAC therapy from Stockholm (Sweden), Denmark, Scotland, Norway, and Germany between 2011 and 2018. Patients were followed from their first prescription until they switched to a vitamin K antagonist, emigrated, died, or the end of follow-up. We measured persistence and adherence over time and defined adequate adherence as medication possession rate ≥90% among persistent patients only. Results Overall, persistence declined to 82% after 1 year and to 63% after 5 years. When including restarters of NOAC treatment, 85% of the patients were treated with NOACs after 5 years. The proportion of patients with adequate adherence remained above 80% throughout follow-up. Persistence and adherence were similar between countries and was higher in patients starting treatment in later years. Both first year persistence and adherence were lower with dabigatran (persistence: 77%, adherence: 65%) compared with apixaban (86% and 75%) and rivaroxaban (83% and 75%) and were statistically lower after adjusting for patient characteristics. Adherence and persistence with dabigatran remained lower throughout follow-up. Conclusion Persistence and adherence were high among NOAC users in five Western European healthcare settings and increased in later years. Dabigatran use was associated with slightly lower persistence and adherence compared with apixaban and rivaroxaban.

Publisher

Oxford University Press (OUP)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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