NOAC Adherence of Patients with Atrial Fibrillation in the Real World: Dosing Frequency Matters?

2019 ◽  
Vol 120 (02) ◽  
pp. 306-313 ◽  
Author(s):  
Jongmin Hwang ◽  
Seongwook Han ◽  
Han-Joon Bae ◽  
Seung-Woon Jun ◽  
Sang-Woong Choi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medication Adherence ◽  
Real World ◽  
Oral Anticoagulants ◽  
Once Daily ◽  
Cardiology Department ◽  
Dosing Frequency ◽  
Adherence Scale ◽  
The Mean ◽  
The Difference

Abstract Background and Objectives Nonvitamin K antagonist oral anticoagulants (NOACs) require stricter medication adherence. We investigated the NOACs adherence in real-world practice. Methods We screened all patients in our cardiology department the day before their outpatient appointment, over a 5-month period. We enrolled 719 consecutive patients who were taking NOACs for atrial fibrillation. The patients were contacted by phone or text to bring the remnant pills with them without any information why. Adherence was measured by the percentage of prescribed doses taken (PDT) (number of doses taken/number of doses expected to be taken from the last prescription × 100 [%]) and the Morisky Medication Adherence Scale (MMAS)-8. Results All 4 NOACs (apixaban 47.8%, dabigatran 21.2%, rivaroxaban 18.4%, and edoxaban 12.6%) were prescribed. The mean duration that the patients had been taking NOACs was 7.2 ± 5.7 months. The PDT was 95.4 ± 9.1% in the once-daily dosing group and 93.4 ± 12.7% in the twice-daily group, and the difference was statistically significant (p = 0.017). The mean MMAS was 2.6 ± 0.8. The proportion of patients with a PDT < 80% was 7.8%. They had a significantly higher MMAS than the PDT ≥ 80% group (3.4 vs. 2.5; p = 0.000). Conclusion Most patients who were taking NOACs had excellent adherence regardless of the dosing frequency. An MMAS ≥ 3 could be used as a simple screening tool for a poor NOAC adherence.

Edoxaban versus placebo, aspirin, or aspirin plus clopidogrel for stroke prevention in atrial fibrillation

2015 ◽  
Vol 114 (08) ◽  
pp. 403-409 ◽  
Author(s):  
Lars Rasmussen ◽  
Torben Larsen ◽  
Andrew Blann ◽  
Flemming Skjøth ◽  
Gregory Lip
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trial ◽  
Real World ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Published Data ◽  
Real World Data ◽  
Once Daily ◽  
Increased Risk ◽  
Reduced Risk

SummaryAs non-valvular atrial fibrillation (AF) brings a risk of stroke, oral anticoagulants (OAC) are recommended. In ‘real world’ clinical practice, many patients (who may be, or perceived to be, intolerant of OACs) are either untreated or are treated with anti-platelet agents. We hypothesised that edoxaban has a better net clinical benefit (NCB, balancing the reduction in stroke risk vs increased risk of haemorrhage) than no treatment or anti-platelet agents. We performed a network meta-analysis of published data from 24 studies of 203,394 AF patients to indirectly compare edoxaban with aspirin alone, aspirin plus clopidogrel, and placebo. Edoxaban 30 mg once daily significantly reduced the risk of all stroke, ischaemic stroke and mortality compared to placebo and aspirin. Compared to aspirin plus clopidogrel, there was a lower risk of intra-cranial haemorrhage (ICH). Edoxaban 60 mg once-daily had a reduced risk of any stroke and systemic embolism compared to placebo, aspirin, and aspirin plus clopidogrel. Mortality rates for both edoxaban doses were estimated to be lower compared to any anti-platelet, and significantly lower compared to placebo. With overall reduced risk of ischemic stroke and ICH, both edoxaban doses bring a NCB of mean (SD) 1.68 (0.15) saved events per 100 patients per year compared to anti-platelet drugs in a clinical trial population. The NCB was demonstrated to be lower, at 0.77 (0.12) events saved (p< 0.01) when modeled to data from a ‘real world’ cohort of AF patients. In conclusion, edoxaban is likely to provide even better protection from stroke and ICH than placebo, aspirin alone, or aspirin plus clopidogrel in both clinical trial populations and unselected community populations. Both edoxaban doses would also bring a positive NCB compared to anti-platelet drugs or placebo/non-treatment based on ‘real world’ data.Note: The review process for this paper was fully handled by Christian Weber, Editor in Chief.

Smartphone Application Helps Improve Adherence to Oral Anticoagulants in Patients with Atrial Fibrillation (Preprint)

2021 ◽  
Author(s):  
Keitaro Senoo ◽  
Tomonori Miki ◽  
Takashi Ohkura ◽  
Hibiki Iwakoshi ◽  
Tetsuro Nishimura ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medication Adherence ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Low Grade ◽  
Grade Group ◽  
Time Points ◽  
The Mean ◽  
High Level

BACKGROUND Atrial fibrillation (AF) is a significant risk factor for stroke, especially in aging societies. Anticoagulation therapy is used to prevent stroke and, the efficacy and safety profiles of novel oral anticoagulants (NOACs) are comparable with those of vitamin-K antagonists (VKAs). Although NOACs do not require regular monitoring of anticoagulatory effects, there are concerns that they tend to be less long-lasting and have poorer adherence among patients than VKAs. A new application (the “Smart AF app”) was developed as a tool to improve adherence to oral anticoagulant medication in elderly individuals with AF. OBJECTIVE The aim of the present study was to evaluate the utility of the Smart AF app in individuals with AF. METHODS Patients with AF were enrolled at Kyoto Prefectural University of Medicine hospitals between May 2019 and September 2020. Follow-up was planned at 1, 3, and 6 months after enrollment, and questionnaire reminders were automatically sent to patient applications at designated follow-up time points. A questionnaire-based survey of medication adherence was performed electronically using the self-reported 8-item Morisky Medication Adherence Scale (MMAS-8) as the survey tool. RESULTS A total of 136 patients with AF were enrolled in this study. During the follow-up period, 111 patients underwent follow-up at 1 month, 109 at 3 months, and 96 at 6 months. The mean age of the enrolled patients was 64.3 years, and males accounted for 79.4% of the study population. The mean CHADS2 score was 1.2, with hypertension being the most common comorbidity. At the time of enrollment, 126 and 10 patients were taking oral NOACs and oral warfarin, respectively. At baseline, mean adherence measured according to the MMAS-8 was 6.14 (SD 1.52), and 6.87 (SD 1.30) at 1 month, 6.69 (SD 1.53) at 3 months, and 6.98 (SD 1.34) at 6 months, demonstrating a significant increase at all time points compared with enrollment (all P<.01). The overall improvement in medication adherence with the intervention was attributed to an improvement of 77.8% in the high-grade group to a high level and 45.3% in the medium-grade group to a high level, and 72% in the low-grade group to a medium or high level. CONCLUSIONS The Smart AF app improved medication adherence, even among elderly patients in whom AF is prevalent. In medication administration, an approach that emphasizes education using mobile health technology, simple reminder function, and patient engagement, may be helpful.

scholarly journals Adherence Rates Between Once and Twice Daily Direct Oral Anticoagulants - Results of a Single University Pharmacy Cohort Study

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5024-5024
Author(s):  
Joseph Shatzel ◽  
Molly Daughety ◽  
Derrick Tao ◽  
Edward Kim ◽  
Sven Olson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Medication Adherence ◽  
Conflicts Of Interest ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Medication Possession Ratio ◽  
Significant Difference ◽  
Dosing Frequency ◽  
The Mean

Abstract INTRODUCTION Direct oral anticoagulants (DOACs) have been shown to have equal or superior efficacy and safety when compared to Vitamin K antagonists, and have become first line therapy for many disease processes. While both the once daily drug rivaroxaban and the twice daily drug apixaban have been shown to be highly effective anticoagulants, it is unknown if differences in their dosing frequency affects patient compliance and, consequently, the likelihood of anticoagulant failure. In this study, we retrospectively evaluated the medication adherence rates of all individuals prescribed therapeutic rivaroxaban or apixaban over a one year period in our pharmacy. METHODS In this retrospective cohort study, we obtained a list of all patients prescribed treatment dose rivaroxaban or apixaban from July 2015 to July 2016 (including the initial loading and maintenance dose) at our university-affiliated pharmacy. We excluded patients who received less than three separate refills or patients on prophylactic or decreased doses. Medication possession ratio for each individual was calculated based on refill dates and means were compared using an unpaired t-test. RESULTS During the study period, there were 756 therapeutically-dosed rivaroxaban or apixaban prescriptions. After excluding individuals who received fewer than three separate refills at our pharmacy (49.3%), 105 rivaroxaban refills and 278 apixaban refills were included (mean prescription size of 32.2 tabs for rivaroxaban and 65.7 tabs for apixaban). In the rivaroxaban group, the mean medication possession ratio across the cohort was 0.9321 (SD=0.1057). In the apixaban group, the mean medication possession ratio across the cohort was 0.9051 (SD=0.1467). The mean difference of the possession ratios was 0.0269 (95% confidence interval -0.0433 to 0.0971, p = 0.4472), thus there was no statistically significant difference in possession ratios between the study drugs. CONCLUSIONS Analyzing our internal pharmacy data, we found that among individuals who filled at least three times, medication adherence was high and not dissimilar between the two groups. Thus, the likelihood of compliance does not appear to be dependent on dosing frequency. However, it should be noted that nearly half of patients filled fewer than three times at our pharmacy and were thus excluded. It is unclear whether these patients completed their prescribed course, discontinued the drug all together or elected to refill at an alternative location, but it is likely that this may have caused an overestimation of drug adherence. While larger studies are needed to further assess adherence between the two drugs, these findings are reassuring that medication compliance between rivaroxaban and apixaban are similar in those who continue the drug. Disclosures No relevant conflicts of interest to declare.

scholarly journals Medication adherence to direct anticoagulants in patients with non-valvular atrial fibrillation – A real world analysis

2021 ◽  
Author(s):  
Catarina Brízido ◽  
António Miguel Ferreira ◽  
Pedro Lopes ◽  
Christopher Strong ◽  
Gustavo Sá Mendes ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Medication Adherence ◽  
Real World ◽  
Direct Anticoagulants

A Modified CGM Algorithm Enhances Data Availability While Retaining iCGM Performance

2021 ◽  
pp. 193229682110075
Author(s):  
Rebecca A. Harvey Towers ◽  
Xiaohe Zhang ◽  
Rasoul Yousefi ◽  
Ghazaleh Esmaili ◽  
Liang Wang ◽  
...  
Keyword(s):  
Data Integration ◽  
Patient Experience ◽  
Real World ◽  
Data Availability ◽  
Post Processing ◽  
Sensor Error ◽  
The Mean ◽  
The Difference ◽  
Data Gap ◽  
Improve Patient

The algorithm for the Dexcom G6 CGM System was enhanced to retain accuracy while reducing the frequency and duration of sensor error. The new algorithm was evaluated by post-processing raw signals collected from G6 pivotal trials (NCT02880267) and by assessing the difference in data availability after a limited, real-world launch. Accuracy was comparable with the new algorithm—the overall %20/20 was 91.7% before and 91.8% after the algorithm modification; MARD was unchanged. The mean data gap due to sensor error nearly halved and total time spent in sensor error decreased by 59%. A limited field launch showed similar results, with a 43% decrease in total time spent in sensor error. Increased data availability may improve patient experience and CGM data integration into insulin delivery systems.

scholarly journals Plasma natriuretic peptide level is an independent determinant of major clinical outcomes in atrial fibrillation patients without heart failure: the Fushimi AF Registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Hamatani ◽  
M Iguchi ◽  
Y Aono ◽  
K Ishigami ◽  
S Ikeda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Clinical Outcomes ◽  
Prognostic Marker ◽  
Oral Anticoagulants ◽  
Systemic Embolism ◽  
The Mean

Abstract Background Atrial fibrillation (AF) increases the risk of death, stroke/systemic embolism and heart failure (HF). Plasma natriuretic peptide (NP) level is an important prognostic marker in HF patients. However, little is known regarding the prognostic significance of plasma NP level in AF patients without HF. Purpose The aim of this study is to investigate the relationship between plasma NP level and clinical outcomes such as all-cause death, stroke/systemic embolism and HF hospitalization during follow-up period in AF patients without HF. Methods The Fushimi AF Registry is a community-based prospective survey of AF patients in our city. The inclusion criterion of the registry is the documentation of AF at 12-lead electrocardiogram or Holter monitoring at any time, and there are no exclusion criteria. We started to enroll patients from March 2011, and follow-up data were available for 4,466 patients by the end of November 2019. From the registry, we excluded 1,220 patients without a pre-existing HF (defined as having one of the following; prior hospitalization for HF, New York Heart Association class ≥2, or left ventricular ejection fraction &lt;40%). Among 3,246 AF patients without HF, we investigated 1,189 patients with the data of plasma BNP (n=401) or N-terminal pro-BNP (n=788) level at the enrollment. We divided the patients according to the quartile of each plasma BNP or NT-pro BNP level and compared the backgrounds and outcomes between these 4 groups stratified by plasma NP level. Results Of 1,189 patients, the mean age was 72.1±10.2 years, 454 (38%) were female and 684 (58%) were paroxysmal AF. The mean CHADS2 and CHA2DS2-VASc score were 1.6±1.1 and 2.9±1.5, respectively. Oral anticoagulants were prescribed in 671 (56%) at baseline. The median (interquartile range) BNP and N-terminal pro-BNP level were 84 (38, 176) and 500 (155, 984) pg/ml, respectively. Patients with high plasma NP level were older, and demonstrated lower prevalence of paroxysmal AF, higher CHADS2 and CHA2DS2-VASc scores and higher prevalence of chronic kidney disease and oral anticoagulants prescription (all P&lt;0.01). A total of 165 all-cause death, 114 stroke/systemic embolism and 103 HF hospitalization occurred during the median follow-up period of 5.0 years. Kaplan-Meier curves demonstrated that higher plasma NP level was significantly associated with the incidences of all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF (Figure 1A). Multivariable Cox regression analysis revealed that plasma NP level could stratify the risk of clinical outcomes even after adjustment by type of AF, CHA2DS2-VASc score, chronic kidney disease and oral anticoagulant prescription (Figure 1B). Conclusion Plasma NP level is a significant prognostic marker for all-cause death, stroke/systemic embolism and HF hospitalization in AF patients without HF, suggesting the importance of measuring plasma NP level in AF patients even without HF. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals The 8-item Morisky medication adherence scale: validation of a Portuguese version in HIV patients

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Aguiar ◽  
C Piñeiro ◽  
R Serrão ◽  
R Duarte
Keyword(s):  
Medication Adherence ◽  
Psychometric Properties ◽  
Reliability Analysis ◽  
Cronbach’S Alpha ◽  
Portuguese Version ◽  
Cronbach's Alpha ◽  
Adherence To Medication ◽  
Morisky Medication Adherence Scale ◽  
Adherence Scale ◽  
The Mean

Abstract Background Antiretroviral therapy (ART) has the most effective treatment for people with HIV, but its effectiveness depends on the individual medication adherence. Morisky Medication Adherence Scale (MMAS-8) is one of the most widely used scales to assess patient adherence. Thus, we aimed to validate a Portuguese version of MMAS-8 and determine its psychometric properties in HIV positive patients. Methods A cross-sectional survey was conducted in Centro Hospitalar Universitário São João (Porto, northern Portugal) at the infectious diseases department. After authorization to use the scale - granted by the author - and, a standard forward-backwards procedure to translate MMAS-8 to Portuguese, the questionnaire was applied to 233 patients with HIV doing ART. Reliability was assessed using Cronbach's alpha and test-retest reliability. Three levels of adherence were considered: 0 to &lt; 6 (low), 6 to &lt; 8 (medium), 8 (high). Results In the studied sample, the mean age was 45.03 years (SD = 11.63), 80.3% men, 19.3% women and 1 transgender, and 53.8% had ≤9 years of education. The mean number of prescribed ART per patient was 1.76. The mean score for the medication adherence scale was 7.29 (SD = 6.74). For the reliability analysis, 12 patients were excluded due to missing data (n = 221). Regarding the level of adherence, 22.5% were low adhering, 71.6% medium and 5.9% high. Corrected item-total correlations showed that 1 item does not correlate very well with the overall scale and was dropped. Scale reliability analysis for the remaining 7 items revealed an overall Cronbach's alpha of 0.661. Women had a protective effect on adherence (OR = 0.31;95%CI:0.15-0.66). Number of years doing ART, age of participants, and type of residence didn't show to be correlated with adherence. Conclusions MMAS-8 is a reliable and valid measure to detect patients at risk of non-adherence. A satisfactory Cronbach's alfa (0.661) was obtained. In general, adherence to medication was medium or high. Key messages This scale can be applied nationwide in other different hospitals, as it could serve as a tool for measuring adherence to ART that can allow for better health care to the ones that are low adhering. A Portuguese version of the MMAS-8 was created for measuring adherence to ART that maintained a similar structure to the original MMAS-8 and good psychometric properties.

Direct Anticoagulants Versus Vitamin K Antagonists in Patients Aged 80 Years or Older With Atrial Fibrillation in a “Real-world” Nationwide Registry: Insights From the FANTASIIA Study

2020 ◽  
Vol 25 (4) ◽  
pp. 316-323
Author(s):  
Martín Ruiz Ortiz ◽  
Javier Muñiz ◽  
María Asunción Esteve-Pastor ◽  
Francisco Marín ◽  
Inmaculada Roldán ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Real World ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Left Ventricular ◽  
Anticoagulant Treatment ◽  
Cancer History

Objective: To describe major events at follow up in octogenarian patients with atrial fibrillation (AF) according to anticoagulant treatment: direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs). Methods: A total of 578 anticoagulated patients aged ≥80 years with AF were included in a prospective, observational, multicenter study. Basal features, embolic events (stroke and systemic embolism), severe bleedings, and all-cause mortality at follow up were investigated according to the anticoagulant treatment received. Results: Mean age was 84.0 ± 3.4 years, 56% were women. Direct oral anticoagulants were prescribed to 123 (21.3%) patients. Compared with 455 (78.7%) patients treated with VKAs, those treated with DOACs presented a lower frequency of permanent AF (52.9% vs 61.6%, P = .01), cancer history (4.9% vs 10.9%, P = .046), renal failure (21.1% vs 32.2%, P = .02), and left ventricular dysfunction (2.4% vs 8.0%, P = .03); and higher frequency of previous stroke (26.0% vs 16.6%, P = .02) and previous major bleeding (8.1% vs 3.6%, P = .03). There were no significant differences in Charlson, CHA2DS2VASc, nor HAS-BLED scores. At 3-year follow up, rates of embolic events, severe bleedings, and all-cause death (per 100 patients-year) were similar in both groups (DOACs vs VKAs): 0.34 vs 1.35 ( P = .15), 3.45 vs 4.41 ( P = .48), and 8.2 vs 11.0 ( P = .18), respectively, without significant differences after multivariate analysis (hazard ratio [HR]: 0.25, 95% confidence interval [CI]: 0.03-1.93, P = .19; HR: 0.88, 95% CI: 0.44-1.76, P = .72 and HR: 0.84, 95% CI: 0.53-1.33, P = .46, respectively). Conclusion: In this “real-world” registry, the differences in major events rates in octogenarians with AF were not statistically significant in those treated with DOACs versus VKAs.

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