Medication Adherence Patterns for Patients with Atrial Fibrillation: A Mixed Methods Study to Understand Patient and Clinician Perspectives

Background: Medication adherence is essential for effective atrial fibrillation (AF) management; however, many patients with AF are non-adherent to these medications, necessitating an understanding of adherence barriers. This mixed-methods study aimed to identify factors influencing oral anticoagulant (OAC) adherence. Methods: A stratified random sample of 2000 patients with non-valvular AF and OAC prescriptions was surveyed from a large, seven state community health system, capturing barriers and facilitators to medication adherence using an adapted version of the Adherence Starts with Knowledge-12 scale. Twenty-eight semi-structured interviews were conducted with a sample of survey respondents to further explore drivers of adherence. Eligible clinicians were surveyed on patient adherence. Survey data were analyzed descriptively and using multivariable regression models. Interview data were analyzed thematically. Results: Of 213 patients with an adherence score available, 31.5% reported non-adherence. Nonadherent patients were more likely to report poor healthcare experiences. Receiving all necessary information from clinicians was positively associated with medication adherence. Interview analyses showed clinician communication about medications and believing that medication can help manage AF were important facilitators of medication adherence. While clinician response rate was low (3.0%), 87% of responding clinicians perceived high non-adherence among patients with AF, citing forgetfulness, cost, and side effects as the main reasons. Conclusion: Most patients reported adherence to their medications, whereas clinicians perceived relatively low adherence among their patients. However, clinicians aligned with patients on the need for improved communication and shared decision making around AF treatment. Interventions that promote clinician and patient communication may be pivotal for optimizing medication adherence, which may lead to improved patient care.