Abstract
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.
How minimally interrupted direct oral anticoagulants affect intraprocedural anticoagulation during atrial fibrillation ablation? Insights from a Japanese single‐center retrospective study