The RElationship of Advanced Education and ADherence (ReAHEAD) on antithrombotic in younger patients with non-valvular atrial fibrillation in Taiwan

BACKGROUND: The prevalence and incidence of non-valvular atrial fibrillation (NVAF) in Taiwan increase with age. Low adherence to oral anticoagulants heightens stroke risk. This study evaluated whether advanced educational intervention could enhance dabigatran adherence in Taiwanese patients with NVAF. METHODS: This multicenter clinical trial in Taiwan enrolled 873 patients aged 20-74 years and newly diagnosed with NVAF. Patients were randomized to receive advanced educational intervention or standard care only. Dabigatran adherence at 12 months was evaluated using the Morisky Medication Adherence Scale (MMAS-8), along with the proportion of subjects reporting "never/rarely forgetting to take dabigatran" at 3, 6, and 9 months, dabigatran discontinuation rate, and the safety outcomes in both groups. RESULTS: Both groups reached the maximum MMAS-8 median score at all visits, showing no significant differences. Adverse event rates were 3.9 % (17/441) in the standard care group, including four stroke and thromboembolic events, versus 4.2 % (18/432) in the advanced educational intervention group, with one stroke and thromboembolic event. Subgroup analysis of patients with initial MMAS-8 scores below 8 points showed a significant difference at sixth month (6 vs. 7, P = 0.011). Over 3, 6, 9, and 12 months, MMAS-8 scores improved in both groups, with the advanced educational intervention group achieving a perfect adherence by 12 months (routine group: 6, 6, 7, 7; advanced group: 6, 7, 7, 8). CONCLUSION: Advanced educational intervention significantly improved dabigatran adherence in younger patients with low initial adherence, demonstrating its potential in managing NVAF in Taiwan. TRIAL REGISTRATION NUMBER: NCT04532528.