Abstract
ObjectiveThe aim of this study was to examine the association between medication adherence and illness perceptions, and to explore the factors associated with poor medication adherence in atrial fibrillation (AF) patients receiving direct oral anticoagulants (DOACs) in a real-world clinical setting.MethodsAn observational cross-sectional pilot study was conducted at a single Japanese university hospital. One hundred and twenty-nine patients who were diagnosed with AF and who were taking DOACs were recruited from outpatients between January 4th and April 25th, 2017. We evaluated medication adherence to DOACs using the Morisky Medication Adherence Scale-8 (MMAS-8) and illness perceptions using the Brief Illness Perception Questionnaire (BIPQ). The patients’ characteristics and clinical data were collected from electronic medical records.ResultsNinety-nine (76.7%) patients (male, n = 74; mean age, 71.4±9.8 years) participated in this study. According to the MMAS-8, 21 (21.2%) of the patients were classified into the poor adherence group (MMAS-8 score of <6), and 78 (78.8%) were classified into the good adherence group (MMAS-8 score of 6–8). A multivariate logistic regression analysis revealed that age (per year, odds ratio [OR] 0.912, 95% confidence interval [CI] 0.853–0.965, p = 0.001), a history of warfarin use (OR 0.181, 95% CI 0.033–0.764, p = 0.019), duration of DOAC exposure (per 100 days, OR 1.245, 95% CI 1.084–1.460, p = 0.001), and the BIPQ emotional response score (per 1 point, OR 1.235, 95% CI 1.015–1.527, p = 0.035) were significantly associated with poor medication adherence in AF patients receiving DOACs.ConclusionPoor medication adherence to DOACs was strongly associated with a stronger emotional response (i.e. stronger feelings of anger, anxiety, and depression), as well as younger age, the absence of a history of warfarin treatment, and longer DOAC exposure. Further evaluation of the factors associated with medication adherence in AF patients and the development and execution of strategies for improving poor adherence are warranted in the real-world clinical setting.
Highlights
Non-valvular atrial fibrillation (AF) is known as one of the most important risk factors for stroke
Medication adherence to direct oral anticoagulants (DOACs) in AF patients duration of DOAC exposure, and the Brief Illness Perception Questionnaire (BIPQ) emotional response score were significantly associated with poor medication adherence in AF patients receiving DOACs
The BIPQ overall score was not included in the multivariate analysis, as we investigated the influence of each illness perception item on medication adherence
Summary
Non-valvular atrial fibrillation (AF) is known as one of the most important risk factors for stroke. Warfarin was the only agent used to prevent stroke in AF; direct oral anticoagulants (DOACs), including dabigatran, rivaroxaban, apixaban, and edoxaban, have been approved for anticoagulation therapy in Japan since 2011. A meta-analysis of clinical trials revealed that DOAC therapy reduced stroke or systemic embolic events by 19% and all-cause mortality by 10% [2]. DOACs have many pharmacological advantages, including a rapid onset/offset of action and a short half-life, predictable pharmacokinetics and pharmacodynamics without the need to constantly monitor the prothrombin time–international normalized ratio (PT-INR), a good safety profile, and fewer drug and food interactions [3]; on the other hand, there have some disadvantages, including high cost and potentially lower treatment motivation due to no PT-INR monitoring as therapeutic index. Physicians should decide which to prescribe DOACs or warfarin for oral anticoagulant (OAC) therapy depending on the patient’s clinical and psychological characteristics
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