What is the clinical evidence from this study?

Study design: Cohort. Population: Non-valvular atrial fibrillation (n=5059). Intervention: Direct Oral Anticoagulants (DOAC). Primary outcome: Non-adherence (Proportion of Days Covered 30-day supply gap) at 1 year.

March 28, 2025Open Access

Non-adherence and non-persistence of Direct Oral Anticoagulants among patients with non-valvular atrial fibrillation: a French retrospective cohort study

Key Result

Direct oral anticoagulants had a non-adherence rate of 24.2% and a non-persistence rate of 28.4% at 1 year among patients with non-valvular atrial fibrillation.

Study Design

Type

Cohort (n=5,059)

Multicenter

Yes

Structured PICO

Population

5,059 adult patients with non-valvular atrial fibrillation prescribed direct oral anticoagulants in France, followed for up to 1 year to assess medication adherence and persistence.

Exposure

Direct oral anticoagulants (apixaban, rivaroxaban, or dabigatran) dispensed in routine primary care.

Outcome

Non-adherence during the implementation phase (defined as Proportion of Days Covered [PDC] < 80%) and non-persistence (defined as a supply gap > 30 days) at 1 year.

A significant proportion of patients with non-valvular atrial fibrillation exhibit sub-optimal adherence and persistence to DOACs at 1 year, particularly younger patients and those on fewer medications, highlighting a need for targeted therapeutic education.

Limitations

Adherence was measured based on dispensing data, which assumes dispensed drugs were taken but cannot confirm actual intake.
The database lacked information on the reasons for non-adherence or non-persistence, making it impossible to distinguish between patient decisions and physician recommendations.
Dates of death were not yet available in the database at the time of data extraction.
Lifestyle characteristics (e.g., smoking status) contained too many missing values and could not be used in the analysis.

Abstract

Non-adherence and non-persistence of direct oral anticoagulants (DOAC) in patients with non-valvular atrial fibrillation remain major concerns. Most studies on non-persistence and non-adherence during the implementation phase (i.e., from the first to the last dose of DOAC) focus only on new DOAC users. We conducted a retrospective cohort study in France in 2018-2019 using the real-world THIN database to determine non-adherence during the implementation phase, non-persistence, and their associated factors among all DOAC users. Non-adherence was defined as the proportion of days covered 30 days. Factors associated with non-adherence or non-persistence were identified using logistic regressions. We included a total of 5,059 DOAC users: 1,358 new users and 3,701 prevalent users. Non-adherence was 18.7% at 6 months and 24.2% at 1 year and non-persistence was 16.1% and 28.4%, respectively. Non-adherence was almost the same in new and prevalent DOAC users and non-persistence was slightly higher in new users. Factors associated with non-adherence and non-persistence were: age < 65 years and having < 5 comedications. Further studies will be needed to quantify the impact of non-adherence or non-persistence.

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