Real-World Adherence and Persistence with Direct Oral Anticoagulants in Adults with Atrial Fibrillation

BACKGROUND Evidence of adherence and persistence patterns in anticoagulation (AC) therapy comparing wtreatment-naive and non-naive patients is lacking. The objective of this study was to evaluate patterns of medication adherence and persistence in a real-world setting among AC-naive and AC-experienced patients with atrial fibrillation (AF) who were treated with direct oral anticoagulants (DOACs). METHODS AF patients newly initiating a DOAC with a minimum of 6 months of continuous health plan enrollment pre and postindex date (first DOAC prescription) were identified from the Truven Health MarketScan Commercial and Medicare Supplemental databases (2009-2013). DOAC adherence (proportion of days covered [PDC]), persistence, and predictors of adherence were assessed at 6 and 12 months postindex. RESULTS Of 66,090 AF patients included, 46.6% (n=30,826) were AC naive and 53.4% (n=35,264) were AC experienced (age: 66.9 +/- 12.7 vs 70.4 +/- 11.4 yrs, p<0.001; male: n=19,132 [62.1%] vs n=21,691 [61.5%], p=0.14, respectively). A majority of patients received dabigatran as their index DOAC (n=49,210; 74.5%). The mean PDC in AC-naive versus AC-experienced patients at 6 and 12 months of follow-up was 72.3% versus 83.3% (p<0.001) and 63.7% versus 79.9% (p<0.001), respectively. Persistence with DOAC therapy in AC-naive and AC-experienced patients at 6 and 12 months ranged from 59.3% and 76.3% (p<0.0001) to 31.6% and 50.2% (p<0.0001), respectively. Predictors of higher DOAC adherence were older age and higher number of concomitant medications. Predictors of lower adherence were higher number of comorbidities and AC-naive user status. CONCLUSION Medication adherence and persistence with DOACs declined over time and both were suboptimal and lower (at 6 and 12 mo postindex) in AC-naive compared to AC-experienced patients. These findings can help target future strategies or interventions for patient education and long-term AC management especially in those patients naive to DOAC therapy. Future investigation should examine potential reasons for differences in DOAC adherence and persistence between AC-experienced versus AC-naive patients and the implications for patient outcomes.