Adesão à terapêutica com anticoagulantes diretos em doentes com fibrilhação auricular não valvular – uma análise de mundo real

Abstract

Introduction and objectivesDirect oral anticoagulants (DOACs) changed the landscape of atrial fibrillation (AF) treatment, but also brought new challenges in terms of accessibility and compliance. The purpose of this study was to assess adherence to DOACs, and predictors of adherence in a population of AF patients. MethodsSingle‐center retrospective study including all patients with non‐valvular AF treated with a DOAC and followed in outpatient general cardiology, whose first DOAC prescription was between 1 April 2016 to August 2018. The number of pharmacy refills from the day of first prescription to 31 August 2018 was counted (by means of an electronic prescription platform). Medication refill adherence (MRA) was calculated by dividing the total days of supply by the number of days under therapy. Non‐compliance was defined as MRA <90%. ResultsA total of 264 patients (120 men, mean age 74 [PLEASE INSERT SYMBOL] 12 years) met the inclusion criteria. The median CHA2DS2VASC score was 3 (interquartile range (IQR) 2‐5) and the median HAS‐BLED was 1 (IQR 1‐2). Rivaroxaban, apixaban, dabigatran and edoxaban were prescribed in 45%, 41%, 24% and 13% of patients, respectively. Throughout the study, 51 patients (19%) used at least two DOACs. Patients were under DOAC for a median period of 439 days (IQR 269‐638), during which the included population adhered to therapy 90% of the time (IQR 75‐100%). Half of the patients (51%) were classified as non‐compliant; therapy duration (adjusted odds ratio (OR) 1.06 per month, 95% confidence interval (CI) 1.03‐1.08, p<0.001), taking DOACs with b.i.d. (adjusted OR 1.73, 95%CI 1.08‐2.75, p=0.022), and higher medication copayments (adjusted OR 2.13, 95%CI 1.28‐3.45, p=0.003) were independent predictors of non‐compliance. ConclusionHalf of the patients (51%) were classified as non‐compliant (medication refill adherence < 90%). Therapy duration, DOACs with b.i.d. posology and higher medication copayments were independent predictors of non‐compliance, which might be targets to improve patient adherence.