Lower adherence to dabigatran was associated with a higher risk of mortality and stroke (HR 1.07; 95% CI 1.03-1.12 per 0.10 decline in proportion of days covered).
Cohort (n=2,882)
Does lower adherence to direct oral anticoagulants increase the risk of mortality and stroke in outpatients with atrial fibrillation?
In a real-world VA population with atrial fibrillation, over 25% of patients had sub-optimal adherence to DOACs, which was associated with an increased risk of mortality and stroke.
Estimación del efecto: HR 1.07 (95% CI 1.03-1.12)
BACKGROUND: The direct oral anticoagulants (DOACs) reduce the risk of stroke in moderate to high-risk patients with non-valvular atrial fibrillation (AF). Yet, concerns remain regarding its routine use in real world practice. We sought to describe adherence patterns and the association between adherence and outcomes to the DOACs among outpatients with AF. METHODS: -VASc score ≥ 2. Adherence was determined using pharmacy refill data and estimated by the proportion of days covered (PDC) over the first year of therapy. Clinical outcomes, including all-cause mortality and stroke, were measured at 6 months and used to assess measures of adherence for each DOAC. RESULTS: A total of 2882 patients were included. Most were prescribed dabigatran (72.7%), compared with rivaroxaban (19.8%) or apixaban (7.5%). The mean PDC was 0.84 ± 0.20 for dabigatran, 0.86 ± 0.18 for rivaroxaban, and 0.89 ± 0.14 for apixaban (p < 0.01). The proportion of non-adherent patients, PDC <0.80, was 27.6% for all and varied according DOAC. Lower adherence to dabigatran was associated with higher risk of mortality and stroke (HR 1.07; 1.03-1.12 per 0.10 decline in PDC). CONCLUSIONS: In a real-world VA population being prescribed anticoagulation for AF, more than one quarter had sub-optimal adherence. Lower adherence was associated with a higher risk of mortality and stroke. Efforts identifying non-adherent patients, and targeted adherence interventions are needed to improve outcomes.
Borne et al. (Sat,) conducted a cohort in non-valvular atrial fibrillation (n=2,882). Direct oral anticoagulants was evaluated on all-cause mortality and stroke (HR 1.07, 95% CI 1.03-1.12). Lower adherence to dabigatran was associated with a higher risk of mortality and stroke (HR 1.07; 95% CI 1.03-1.12 per 0.10 decline in proportion of days covered).
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