- •1/3 of patients with atrial fibrillation had poor adherence to oral anticoagulants.
- •Good adherence to oral anticoagulants was related to less adverse events.
- •Acenocoumarol was associated with more adverse events than direct oral anticoagulants.
To explore the implications of adherence to oral anticoagulants (OACs) on all-cause mortality and cardiovascular outcomes in patients with atrial fibrillation (AF).
This post-hoc analysis of the MISOAC-AF trial included recently hospitalized patients with AF. Adherence to OACs was assessed by the proportion of days covered (PDC). Good adherence was defined as PDC >80 %. Cox regression models were used to associate PDC with clinical outcomes of all-cause death, cardiovascular death (CVD), stroke, and bleeding. A sub-analysis was performed among adherent patients to compare outcomes between vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs).
During a median 31-month follow-up, 778 cardiac patients with comorbid AF who had been prescribed OACs upon hospital discharge were studied. The mean PDC was 0.78; 66 % of patients had good adherence (>80 %) which was associated with lower risk of all-cause death [adjusted hazard ratio (aHR): 0.64; 95 % confidence interval (CI): 0.46 to 0.84, p < 0.001] and CVD (aHR: 0.70; 95 % CI: 0.50 to 0.97, p = 0.03). The risk of stroke and major or non-major bleeding did not differ by adherence status. Among adherent patients to OACs, VKA use was associated with higher rates of all-cause death (p < 0.001), CVD (p < 0.001), and stroke (p = 0.01); no differences were found regarding major or non-major bleeding risk.
In recently hospitalized patients with AF, good adherence to OACs was associated with a reduced risk of all-cause death and CVD. The rates of stroke or bleeding events were not significantly different. VKAs were associated with more adverse events compared to DOACs.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Cardiology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).in: European Heart Journal. Vol. 42. Oxford University Press, 2021: 373-498
- Multimorbidity and co-morbidity in atrial fibrillation and effects on survival: findings from UK Biobank cohort.EP Europace. 2018 Nov 1; 20 ([cited 2022 May 30]) (Available from: https://academic.oup.com/europace/article/20/FI_3/f329/4582725): f329-f336
- Real-world adherence and persistence to direct Oral anticoagulants in patients with atrial fibrillation:a systematic review and meta-analysis.Circ Cardiovasc Qual Outcomes. 2020; 13e005969
- Effectiveness and safety of DOACs vs. VKAs in AF patients with cancer: evidence from randomized clinical trials and observational studies.Front Cardiovasc Med. 2021 Nov 5; 8
- Adherence to oral anticoagulants among patients with atrial fibrillation: a systematic review and meta-analysis of observational studies.BMJ Open [Internet]. 2020 Apr 1; 10 (Available from: https://bmjopen.bmj.com/content/10/4/e034778)e034778
- Use of direct oral anticoagulants in patients with atrial fibrillation in Scotland: applying a coherent framework to drug utilisation studies.Pharmacoepidemiol Drug Saf [Internet]. 2017 Nov 1; 26 (Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/pds.4272): 1378-1386
- Primary nonadherence to oral anticoagulants in patients with atrial fibrillation: real-world data from a population-based cohort.J Manag Care Spec Pharm [Internet]. 2018 May 1; 24 (Available from: www.jmcp.org): 440-448
- Treatment and persistence with oral anticoagulants among newly diagnosed patients with non-valvular atrial fibrillation: a retrospective observational study in a US commercially insured and Medicare Advantage population.BMJ Open [Internet]. 2018 Jun 1; 8 (Available from: https://bmjopen.bmj.com/content/8/6/e020676)e020676
- Adherence to rivaroxaban versus apixaban among patients with non-valvular atrial fibrillation: analysis of overall population and subgroups of prior oral anticoagulant users.PLoS One [Internet]. 2018 Apr 1; 13 (Available from: /pmc/articles/PMC5886396/)
- Dabigatran persistence and adherence in New Zealand: a nationwide retrospective observational study.BMJ Open [Internet]. 2018 Apr 1; 8 (Available from: https://bmjopen.bmj.com/content/8/4/e020212)e020212
- Adherence to anticoagulant treatment with apixaban and rivaroxaban in a real-world setting.Clin Trials Regul Sci Cardiol. 2016 Jun; 1: 1-4
- Rationale and design of a randomized study comparing Motivational Interviewing to Support Oral Anticoagulation adherence versus usual care in patients with nonvalvular atrial fibrillation: The MISOAC-AF trial [Internet].in: Hellenic Journal of Cardiology. Vol. 61. Hellenic Cardiological Society, 2020: 453-454 (Available from: https://pubmed.ncbi.nlm.nih.gov/32259588/)
- Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with non-valvular Atrial Fibrillation (MISOAC-AF): a randomized clinical trial.Eur Heart J Cardiovasc Pharmacother [Internet]. 2021 Apr 9; 7 (Available from: https://academic.oup.com/ehjcvp/article/7/FI1/f63/5825732): f63-f71
Nau DP. Proportion of Days Covered (PDC) as a Preferred Method of Measuring Medication Adherence.
- Adherence measures.([Internet]. Available from)
- Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients.J Thromb Haemost [Internet]. 2005 Apr 1; 3 (Available from https://onlinelibrary.wiley.com/doi/full/10.1111/j.1538-7836.2005.01204.x): 692-694
- Multimorbidity and the risk of hospitalization and death in atrial fibrillation: a population-based study.Am Heart J [Internet]. 2017 Mar; 1 (Available from https://pubmed.ncbi.nlm.nih.gov/28267478/): 74-84
- Mortality outcomes in patients receiving direct oral anticoagulants: a systematic review and meta-analysis of randomized controlled trials.J Thromb Haemost [Internet]. 2015 Nov 1; 13 (Available from https://pubmed.ncbi.nlm.nih.gov/26356595/): 2012-2020
- Adherence to anticoagulation and risk of stroke among Medicare beneficiaries newly diagnosed with atrial fibrillation.Am J Cardiovasc Drugs [Internet]. 2020 Apr 1; 20 (Available from https://pubmed.ncbi.nlm.nih.gov/31523759/): 199-207
- Adherence to oral anticoagulation in ischemic stroke patients with atrial fibrillation.Ann Med [Internet]. 2021; 53 (Available from https://www.tandfonline.com/doi/abs/10.1080/07853890.2021.1968031): 1613-1620
- All-cause mortality and cardiovascular outcomes with non-vitamin K oral anticoagulants versus warfarin in patients with heart failure in the Food and Drug Administration adverse event reporting system.Am J Ther [Internet]. 2019; 26 (Available from https://pubmed.ncbi.nlm.nih.gov/31145139/): e671-e678
- Original research article: mortality and oral anticoagulants in the Food and Drug Administration Adverse Event Reporting System.Open Heart [Internet]. 2017 Jun 1; 4 (Available from: /pmc/articles/PMC5515169/)
- Identification and weighting of the most critical “real-life” drug-drug interactions with acenocoumarol in a tertiary care hospital.Eur J Clin Pharmacol [Internet]. 2013 Mar; 69 (Available from https://pubmed.ncbi.nlm.nih.gov/22903542/): 617-627
- Estimating the effect of medication adherence on health outcomes among patients with type 2 diabetes-an application of marginal structural models.Value Health. 2010; 13: 1038-1045
- Medication taking behaviors in patients taking warfarin versus direct oral anticoagulants: a systematic review.Expert Rev Cardiovasc Ther. 2019 Jun 3; 17: 427-434
- Factors associated with anticoagulation adherence in Chinese patients with non-valvular atrial fibrillation.Patient Prefer Adherence [Internet]. 2021 Mar; 1 (Available from https://www.dovepress.com/factors-associated-with-anticoagulation-adherence-in-chinese-patients–peer-reviewed-fulltext-article-PPA): 493-500
- Medication adherence influencing factors - an (updated) overview of systematic reviews.Syst Rev [Internet]. 2019 May 10; 8 (Available from https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-019-1014-8): 1-17
- A smartphone app to improve oral anticoagulation adherence in patients with atrial fibrillation: prospective observational study.JMIR Mhealth Uhealth [Internet]. 2022 Jan 1; 10 (Available from: /pmc/articles/PMC8783280/)
- Optimizing adherence and persistence to non-vitamin K antagonist oral anticoagulant therapy in atrial fibrillation.Eur Heart J Suppl [Internet]. 2022 Feb 16; 16;24 (Available from: https://academic.oup.com/eurheartjsupp/article/24/Supplement_A/A42/6529571): A42-A55
Published online: October 10, 2022
Accepted: September 5, 2022
Received in revised form: August 31, 2022
Received: August 1, 2022
© 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved. All rights reserved.