Glowacki Nicole, Guzman Iridian, Mills J Rebecca, Parks Ann, Ateya Mohammad, Dai Feng, Dorscheid Holly, Khatib Rasha
Advocate Aurora Research Institute, Advocate Health, 945 N 12th St, Milwaukee, WI, 53233, USA.
Pfizer Inc, US Medical Affairs, New York, NY, USA.
Cardiol Ther. 2025 Mar;14(1):53-69. doi: 10.1007/s40119-024-00395-0. Epub 2025 Jan 3.
Oral anticoagulants (OAC) reduce the risk of stroke among patients with atrial fibrillation (AF). However, adherence remains suboptimal. We focused on primary nonadherence to OAC and its associations with patient characteristics-specifically social determinants of health collected in electronic health records (EHR).
This retrospective cohort study used EHR data linked to prescription fill data from a large, integrated Midwestern community healthcare system. Adult patients with an incident AF diagnosis from 2020 to 2021 and a first OAC prescription (index visit) were included. Primary nonadherence was defined as failure to fill an initial OAC prescription within 30 days. Outcomes included 1-year all-cause mortality, first stroke, and first bleed after first OAC prescription. Multivariable logistic regression models evaluated the likelihood of primary nonadherence, and multivariable Cox proportional hazard models evaluated the association between primary nonadherence with outcomes.
Among 8679 patients, 46% were female, 82% were non-Hispanic white, and the mean age was 71.3 ± 12.1 years. Twenty-one percent were primary nonadherent. The odds of primary nonadherence were greater among patients who were non-Hispanic Black, older (≥ 75 years), male, lacking commercial insurance, not employed/retired, and referred to social work; similar results were observed for secondary nonadherence. Primary nonadherence was associated with an increased risk of all-cause mortality (hazard ratio, 1.69; 95% confidence interval, 1.42-2.01).
These results reveal disparities in primary nonadherence among patients with a new AF diagnosis. There is a need to develop and test interventions for primary nonadherence that are implemented in disadvantaged patients, among whom nonadherence is highest.
口服抗凝药（OAC）可降低心房颤动（AF）患者的中风风险。然而，依从性仍然不理想。我们关注的是对OAC的初次不依从及其与患者特征（特别是电子健康记录（EHR）中收集的健康社会决定因素）之间的关联。
这项回顾性队列研究使用了与来自一个大型综合中西部社区医疗系统的处方配药数据相关联的EHR数据。纳入了2020年至2021年首次诊断为AF并首次开具OAC处方（索引就诊）的成年患者。初次不依从定义为在30天内未填充初始OAC处方。结局包括首次OAC处方后的1年全因死亡率、首次中风和首次出血。多变量逻辑回归模型评估初次不依从的可能性，多变量Cox比例风险模型评估初次不依从与结局之间的关联。
在8679名患者中，46%为女性，82%为非西班牙裔白人，平均年龄为71.3±12.1岁。21%的患者初次不依从。非西班牙裔黑人、年龄较大（≥75岁）、男性、缺乏商业保险、未就业/退休以及被转介至社会工作的患者初次不依从的几率更高；继发性不依从也观察到类似结果。初次不依从与全因死亡率增加的风险相关（风险比，1.69；95%置信区间，1.42 - 2.01）。
这些结果揭示了新发AF诊断患者初次不依从方面的差异。有必要开发并测试针对初次不依从的干预措施，这些措施应在不依从率最高的弱势患者中实施。
