Collaboration for Outcomes Research & Evaluation (CORE), University of British Columbia, Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, University of British Columbia, Canada.
Faculty of Pharmaceutical Sciences, University of British Columbia, Canada; Data Analytics, Statistics and Informatics, Faculty of Pharmaceutical Sciences, University of British Columbia, Canada.
Res Social Adm Pharm. 2022 Nov;18(11):3920-3928. doi: 10.1016/j.sapharm.2022.06.002. Epub 2022 Jun 11.
Adherence to oral anticoagulants (OACs) in patients with atrial fibrillation (AF) is important in preventing stroke. The dominance of retrospective studies using administrative data has led to a lack of data on psychosocial determinants of adherence and prevented comparison of adherence between OAC drug classes. OAC switching is another aspect of adherence that is unexplored.
A prospective design was utilized to measure AF patients' self-reported adherence and OAC switching, and to identify their clinical, demographic, and psychosocial determinants. Participants were recruited from specialized AF clinics in Canada and followed for up to 2 years. Data were collected via telephone every 3-4 months using a structured survey. Adherence was measured using the Morisky Medication Adherence scale (©MMAS-8).
The included participants (N = 306) were followed for a median follow up time of 14.1 months and had an average of 3.2(SD 1.4) study visits. The mean self-reported adherence on the ©MMAS-8 was 7.28(SD 0.71) for patients receiving care at specialized AF clinics. Older age, experiencing a bleed, and higher satisfaction with the burden of medications were significantly associated with higher adherence. Drug class did not have any significant impact on adherence. 7.8% of the cohort experienced a switch with most of them being from warfarin to DOAC. Taking warfarin as the index medication, experiencing a bleed and older age were significantly associated with higher odds of switching.
Patients with AF reported high adherence to their OAC therapy however being on DOAC may not translate to better adherence compared to VKA. Improving satisfaction with the burden of therapy is important in improving adherence.
在房颤（AF）患者中，坚持使用口服抗凝剂（OAC）对于预防中风非常重要。由于回顾性研究主要依赖于行政数据，导致缺乏关于依从性的社会心理决定因素的数据，并阻止了对 OAC 药物类别之间的依从性进行比较。OAC 转换是另一个尚未探索的依从性方面。
采用前瞻性设计来衡量 AF 患者的自我报告依从性和 OAC 转换，并确定其临床、人口统计学和社会心理决定因素。参与者从加拿大的专门 AF 诊所招募，并随访了长达 2 年。通过电话每隔 3-4 个月使用结构化调查收集数据。依从性使用 Morisky 药物依从性量表（©MMAS-8）进行测量。
纳入的参与者（N=306）的中位随访时间为 14.1 个月，平均有 3.2（SD 1.4）次研究访问。在专门的 AF 诊所接受治疗的患者的 ©MMAS-8 自我报告依从率平均值为 7.28（SD 0.71）。年龄较大、经历出血和对药物负担的满意度较高与较高的依从性显著相关。药物类别对依从性没有任何显著影响。该队列中有 7.8%的患者发生了转换，其中大多数从华法林转换为 DOAC。以华法林作为指数药物，经历出血和年龄较大与更高的转换几率显著相关。
AF 患者报告了对其 OAC 治疗的高度依从性，但与 VKA 相比，使用 DOAC 可能不会转化为更好的依从性。提高对治疗负担的满意度对于提高依从性很重要。
