Thrombosis Expert Center Maastricht and Laboratory for Clinical Thrombosis and Hemostasis, Maastricht, The Netherlands.
Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
Acta Haematol. 2022;145(5):476-483. doi: 10.1159/000524094. Epub 2022 Mar 18.
Long-term treatment with direct oral anticoagulants (DOAC) is required for the majority of patients with nonvalvular atrial fibrillation (AF) to prevent ischemic stroke and systemic embolism. Adherence to therapy may impact clinical outcomes. Therefore, the purpose of this study was to assess the potential impact of structured follow-up on long-term adherence to DOAC therapy compared to standard care.
This is a cross sectional study on the implementation phase of medication adherence to DOACs, comparing patients with AF following completion of structured follow-up of minimally 1 year with those who received standard care. All patients used DOACs for more than 2 years and completed a questionnaire on adherence. Adherence was measured with the Morisky Medication Adherence Scale-8 (MMAS-8) score and assessed via an online web portal.
A total of 212 patients were included. The mean MMAS-8 score was 7.55 (SD 0.93) after structured follow-up and 7.25 (SD 1.01) for standard care; p = 0.045. Following structured follow-up 64.1% of patients had a high adherence (MMAS score of 8) compared to 50% receiving standard care; p = 0.05. Patients following structured follow-up on a once daily DOAC regime had higher MMAS-8 scores compared to those on a twice daily regime; 7.74 (SD 0.74) versus 7.00 (SD 1.22); p < 0.001. The rates of minor bleedings were 10.6% versus 21.4% respectively, p = 0.038.
In patients on long-term DOAC treatment, adherence to therapy was significantly increased after receiving an initial period of structured follow-up compared to standard care. Additionally, adherence to DOAC therapy was higher with once-daily treatment regimen. Significant more minor bleedings were reported in the standard care group. These results indicate that implementation of structured follow-up of patients with AF using DOACs merits further evaluation.
大多数非瓣膜性心房颤动（AF）患者需要长期服用直接口服抗凝剂（DOAC）以预防缺血性卒中和全身性栓塞。治疗的依从性可能会影响临床结果。因此，本研究的目的是评估与标准护理相比，结构化随访对长期 DOAC 治疗依从性的潜在影响。
这是一项关于 DOAC 药物依从性实施阶段的横断面研究，比较了完成至少 1 年结构化随访的 AF 患者与接受标准护理的患者。所有患者均使用 DOAC 治疗超过 2 年，并完成了一份关于依从性的问卷。依从性通过 Morisky 药物依从性量表-8（MMAS-8）评分进行测量，并通过在线网络门户进行评估。
共纳入 212 例患者。结构化随访后 MMAS-8 评分平均为 7.55（SD 0.93），标准护理组为 7.25（SD 1.01）；p = 0.045。结构化随访后，64.1%的患者具有较高的依从性（MMAS 评分 8），而接受标准护理的患者为 50%；p = 0.05。接受每日一次 DOAC 治疗方案的患者 MMAS-8 评分高于每日两次治疗方案的患者；7.74（SD 0.74）与 7.00（SD 1.22）；p < 0.001。两组患者的轻微出血发生率分别为 10.6%和 21.4%；p = 0.038。
在长期接受 DOAC 治疗的患者中，与标准护理相比，接受初始结构化随访后，治疗依从性显著提高。此外，每日一次治疗方案的 DOAC 治疗依从性更高。标准护理组报告的轻微出血事件更多。这些结果表明，对使用 DOAC 的 AF 患者实施结构化随访值得进一步评估。
