Medication Adherence and Antithrombotic Therapy Outcomes

Figures

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  Figure 1. Patient Flow of the Subanalysis Population This figure illustrates the patient selection process for the adherence subanalysis within the AFIRE study. Of the total AFIRE population, 2,120 patients answered the self-reported adherence questionnaire and were included in this subanalysis. Patients were subsequently categorized based on adherence to rivaroxaban (adherent vs nonadherent) and treatment strategy (rivaroxaban monotherapy vs combination therapy). This classification formed the basis for evaluating efficacy and safety outcomes. AFIRE = Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease.

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  Figure 2. Outcomes by Medication Adherence and Treatment Strategy Kaplan-Meier curves show the primary efficacy (A) and safety (B) endpoints in the combination therapy group vs rivaroxaban monotherapy among adherent (red) and nonadherent patients (blue). Medication adherence was evaluated using a self-reported questionnaire. Cox regression models adjusted for age and sex were used to estimate HRs. Rivaroxaban monotherapy was associated with improved efficacy and safety in adherent patients, whereas such advantages were not apparent in nonadherent patients. Combi = combination therapy; Mono = rivaroxaban monotherapy.

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  Figure 3. Outcomes in the Angina Subgroup by Medication Adherence Kaplan-Meier curves show the primary efficacy (A) and safety (B) endpoints among adherent (red) and nonadherent (blue) groups with a history of angina pectoris. Medication adherence was assessed using self-reported questionnaires. In the primary efficacy endpoint, adherent patients showed better outcomes than nonadherent patients (P = 0.04), whereas no significant difference was observed in the primary safety endpoint. Cox regression models adjusted for age and sex were used to estimate HRs.

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  Figure 4. Landmark Analysis From 6 Months by Adherence Status Kaplan-Meier curves from 6 months onward for primary efficacy (A) and safety (B) endpoints comparing combination therapy with rivaroxaban monotherapy among adherent (red) and nonadherent (blue) patients. Only patients who were event-free at 6 months were included in this analysis. Medication adherence was assessed using self-reported questionnaires. Among adherent patients, trends consistent with the full cohort was observed for both efficacy and safety, although the difference in safety was not statistically significant (P = 0.101). This difference was not apparent among nonadherent patients. P values were calculated using the log-rank test. Abbreviations as in Figure 2.

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  Central Illustration. Clinical Outcomes Based on Medication Adherence in the Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease Study In this post hoc analysis of the AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial comparing rivaroxaban monotherapy with combination therapy in patients with atrial fibrillation (AF) and coronary artery disease (CAD), medication adherence was assessed using a self-reported questionnaire (n = 2,120). Patients who answered “I take it as prescribed” were defined as adherent, accounting for 94.9% of the population. Among adherent patients (red), rivaroxaban monotherapy showed greater benefit in the primary efficacy endpoint, whereas these advantages were not apparent in nonadherent patients (blue). HRs were adjusted for age and sex. This post hoc analysis highlights the importance of adherence in optimizing clinical outcomes for patients with AF and CAD. Combi = combination therapy; Mono = rivaroxaban monotherapy.