van der Horst Sabine F B, de Vries Tim A C, Chu Gordon, Bavalia Roisin, Xiong Helen, van de Wiel Kayleigh M, Mulder Kelly, van Ballegooijen Hanne, de Groot Joris R, Middeldorp Saskia, Klok Frederikus A, Hemels Martin E W, Huisman Menno V
Department of Thrombosis and Hemostasis, Leiden UMC, Leiden, The Netherlands.
Department of Clinical and Experimental Cardiology and Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Heart Center, Amsterdam, The Netherlands.
TH Open. 2023 Sep 27;7(3):e270-e279. doi: 10.1055/a-2161-0928. eCollection 2023 Jul.
For most patients with newly diagnosed atrial fibrillation (AF), direct oral anticoagulants (DOACs) are preferred over vitamin K antagonists. However, there is concern that the lack of monitoring may impair therapy adherence and therefore the anticoagulant effect. To assess 1-year DOAC nonadherence in patients with AF and a treatment indication of at least 1 year in the Dutch health care setting, and to identify predictors of nonadherence. We performed a near-nationwide historical cohort study in patients with a novel DOAC indication for AF. Data were obtained from a pharmacy database, covering 65% of all outpatient prescriptions dispensed in the Netherlands. The 1-year nonadherence was assessed by the proportion of days covered; the threshold was set at <80%. Robust Poisson regression analyses were performed to identify predictors of nonadherence. A total of 46,211 patients were included and the 1-year nonadherence was 6.5%. We identified male sex (risk ratio [RR] 1.23, 95% confidence interval [CI]: 1.15-1.33), younger age (age ≥60 to <70 years: RR: 1.15, 95% CI: 1.00-1.33, age <60 years: RR: 2.22, 95% CI: 1.92-2.57; reference age ≥85 years), a reduced DOAC dose (RR: 1.10, 95% CI: 1.00-1.22), a twice-daily dosing regimen (RR: 1.21, 95% CI: 1.12-1.30), and treatment with apixaban (RR: 1.16, 95% CI: 1.06-1.26, reference rivaroxaban) or dabigatran (RR: 1.25, 95% CI: 1.14-1.37) as independent predictors of 1-year nonadherence. One-year nonadherence to DOACs was low yet relevant in patients with AF newly prescribed a DOAC. Understanding the predictors for nonadherence may help identify patients at risk.
对于大多数新诊断为房颤（AF）的患者，直接口服抗凝剂（DOACs）比维生素K拮抗剂更受青睐。然而，人们担心缺乏监测可能会影响治疗依从性，进而影响抗凝效果。
为评估荷兰医疗环境中房颤患者且治疗指征至少为1年的患者1年的DOAC不依从情况，并确定不依从的预测因素。
我们对有新型DOAC治疗房颤指征的患者进行了一项近乎全国范围的历史性队列研究。数据来自一个药房数据库，涵盖荷兰所有门诊处方的65%。通过覆盖天数的比例评估1年的不依从情况；阈值设定为<80%。进行稳健的泊松回归分析以确定不依从的预测因素。
共纳入46,211名患者，1年的不依从率为6.5%。我们确定男性（风险比[RR]1.23，95%置信区间[CI]：1.15 - 1.33）、年龄较轻（年龄≥60至<70岁：RR：1.15，95%CI：1.00 - 1.33，年龄<60岁：RR：2.22，95%CI：1.92 - 2.57；参考年龄≥85岁）、DOAC剂量减少（RR：1.10，95%CI：1.00 - 1.22）、每日两次给药方案（RR：1.21，95%CI：1.12 - 1.30）以及使用阿哌沙班（RR：1.16，95%CI：1.06 - 1.26，参考利伐沙班）或达比加群（RR：1.25，95%CI：1.14 - 1.37）治疗是1年不依从的独立预测因素。
新开具DOAC的房颤患者1年的DOAC不依从率较低但仍值得关注。了解不依从的预测因素可能有助于识别有风险的患者。
