March 23, 2021EP EuropaceOpen Access

Persistence and adherence to non-vitamin K antagonist oral anticoagulant treatment in patients with atrial fibrillation across five Western European countries

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Why the study?

To assess persistence and adherence to NOAC treatment in patients with AF across five Western European healthcare settings.

Does the type of NOAC affect long-term persistence and adherence in patients with atrial fibrillation?

Structured PICO

Does the type of NOAC affect long-term persistence and adherence in patients with atrial fibrillation?

Population

559,445 patients with atrial fibrillation initiating non-vitamin K antagonist oral anticoagulant (NOAC) therapy between 2011 and 2018

Intervention

Non-vitamin K antagonist oral anticoagulant (NOAC) therapy (apixaban, rivaroxaban, dabigatran)

Comparator

Comparisons between different NOACs (dabigatran vs apixaban and rivaroxaban)

Outcome

Persistence and adherence to NOAC treatment over time (adequate adherence defined as medication possession rate ≥90% among persistent patients)

Persistence and adherence to NOACs in AF patients remain high over 5 years, though slightly lower for dabigatran compared to apixaban and rivaroxaban.

Implication

NOAC persistence declines over 5 years despite high adherence; leaves open whether interventions can sustain long-term use in AF.

Abstract

AIMS: To assess persistence and adherence to non-vitamin K antagonist oral anticoagulant (NOAC) treatment in patients with atrial fibrillation (AF) in five Western European healthcare settings. METHODS AND RESULTS: We conducted a multi-country observational cohort study, including 559 445 AF patients initiating NOAC therapy from Stockholm (Sweden), Denmark, Scotland, Norway, and Germany between 2011 and 2018. Patients were followed from their first prescription until they switched to a vitamin K antagonist, emigrated, died, or the end of follow-up. We measured persistence and adherence over time and defined adequate adherence as medication possession rate ≥90% among persistent patients only. RESULTS: Overall, persistence declined to 82% after 1 year and to 63% after 5 years. When including restarters of NOAC treatment, 85% of the patients were treated with NOACs after 5 years. The proportion of patients with adequate adherence remained above 80% throughout follow-up. Persistence and adherence were similar between countries and was higher in patients starting treatment in later years. Both first year persistence and adherence were lower with dabigatran (persistence: 77%, adherence: 65%) compared with apixaban (86% and 75%) and rivaroxaban (83% and 75%) and were statistically lower after adjusting for patient characteristics. Adherence and persistence with dabigatran remained lower throughout follow-up. CONCLUSION: Persistence and adherence were high among NOAC users in five Western European healthcare settings and increased in later years. Dabigatran use was associated with slightly lower persistence and adherence compared with apixaban and rivaroxaban.