Key result
A mixed intervention of patient education and a reminder calendar significantly improved average dabigatran adherence at 12 months compared to usual care (89.20% vs 63.22%; NNT 3.84).
Why the study?
Does a mixed intervention of education and a reminder calendar improve dabigatran adherence in patients with non-valvular atrial fibrillation?
RCT (n=726)
cluster randomization
Yes
Does a mixed intervention of education and a reminder calendar improve dabigatran adherence in patients with non-valvular atrial fibrillation?
A simple mixed intervention of patient education and a reminder calendar significantly improves adherence to dabigatran in patients with non-valvular atrial fibrillation.
May support adherence interventions in practice; leaves open randomized confirmation of outcomes.
Objective To assess the efficacy of a mixed intervention, educational, and reminder calendar of the intake, as a strategy to improve therapeutic adherence with dabigatran in patients with non-valvular atrial fibrillation (NVAF). Methods This was a prospective, longitudinal, multi-center study, carried out in 110 specialized healthcare centers in Spain. Seven hundred and twenty-six patients treated with dabigatran prescribed for stroke prevention were included. A cluster randomization was performed based on two groups: (1) Control Group (CG) as usual clinical practice, and (2) Intervention Group (IG) with a mixed strategy: (a) Healthcare education, and (b) Use of a reminder calendar for taking the anticoagulant medication. Three visits took place: baseline and follow-up at 6 and 12 months. Compliance was measured by using electronic monitors (MEMS). Average adherence percentage (%; Average AP) and daily compliance (%; Daily AP) was calculated. A patient was considered adherent when AP was 80-100%. Results Six hundred and twenty-five patients completed the study (315 in the IG and 310 in the CG). Daily AP was 91.97% at 6 months and 91.05% after 12 months in the IG and 82.26% and 82.63% in the CG. Average adherence was 90.79% and 89.20% in the IG and 64.51% and 63.22% in the CG at 6 and 12 months, respectively. Significant differences were observed in the Daily AP and Average AP, with higher percentages in the IG. In the non-adherents group, the number of concomitant drugs, baseline, and 6 months SBP values, 6 and 12 months DBP values, and weight, total cholesterol, and LDL cholesterol were significantly higher. The number needed to treat (NNT) was 3.84 patients to prevent one non-adherence. Conclusions A mixed intervention, consisting of patient education and a simple calendar reminder of drug intake, is an effective strategy to improve dabigatran therapeutic adherence in patients with NVAF. The percentage of adherence with dabigatran was high.
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Contreras et al. (2018) conducted an RCT in non-valvular atrial fibrillation (NVAF) (n=726). Mixed strategy (healthcare education and reminder calendar) vs. Usual clinical practice was evaluated on Average adherence percentage at 12 months (NNT 3.84). A mixed intervention of patient education and a reminder calendar significantly improved average dabigatran adherence at 12 months compared to usual care (89.20% vs 63.22%; NNT 3.84).
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