Why the study?
Poor adherence to oral anticoagulants is a significant problem in AF that increases thromboembolic risk, particularly in patients with comorbid hypertension, diabetes mellitus, and hyperlipidemia.
Adherence to oral anticoagulants in atrial fibrillation patients with multiple comorbidities is suboptimal, with distinct trajectory patterns that could inform tailored interventions.
Adherence trajectories in comorbid AF may guide future interventions; leaves open which patterns predict events or warrant targeting.
Background Poor adherence to oral anticoagulants is a significant problem in atrial fibrillation (AF), especially among patients with comorbid hypertension (HTN), diabetes mellitus (DM), and hyperlipidemia as it increases the risk for cardiac and thromboembolic events. Group-based trajectory modeling (GBTM) has been used to depict longitudinal patterns of adherence. Aim This primary objective was to describe adherence trajectory patterns of direct oral anticoagulants (DOACs) or warfarin among AF patients with HTN, DM, and hyperlipidemia using GBTM. The secondary objective was to report the clinical outcomes and concomitant drug use among DOAC/warfarin cohort Method This retrospective study was conducted among continuously enrolled Medicare Advantage Plan from January 2016-December 2019. AF patients were included in this study if they had comorbid HTN, DM, and hyperlipidemia with at least one pharmacy claim for warfarin/DOAC prescription. Monthly adherence to DOAC/warfarin was measured using proportion of days covered (PDC) and then modeled in a logistic GBTM to describe patterns of adherence. Patient’s demographic, clinical characteristics, and concomitant use of DOACs/warfarin with CYP3A4,P-gp inhibitors were measured and compared across trajectories. Results Among 317 patients, 137 (59.62%) and 79 (24.92%) were DOAC, and warfarin users, respectively. The trajectory model for DOACs included gradual decline in adherence (GD, 40.4%), adherent (38.8%), and rapid decline (RD, 20.8%). The trajectories for warfarin adherence included gradual decline (GD, 18.9%), adherence (59.4%), and gaps in adherence (GA, 21.7%). Conclusion Adherence to oral anticoagulants is suboptimal. Interventions tailored according to past adherence trajectories may be effective in improving patient’s adherence.
No takes yet. Share an insight, caveat, or question.
Mohan et al. (2022) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: