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• W2892419993 abstract "Retrospective studies have shown that AF patients frequently discontinue, switch, or are non-adherent with oral anticoagulants (OAC). Few studies have explored AF patients’ experiences with therapy and their behavior. This study characterized OAC persistence, switching, self-reported adherence, and therapy satisfaction in AF patients. Prospective cohort study involving telephone interviews every 3-4 months of AF patients from five specialized AF clinics in BC. We enrolled 388 patients [41% female, mean age 69 years (SD 10), CCS-SAF score 1.7 (SD 1.2), CHA2DS2-VASc 2.7 (SD 1.5), HAS-BLED 1.4 (SD 1.1)] and followed them for median 14.1 months/patient. Data was analyzed for the 357 participants who completed at least one follow up visit. Index OACs were rivaroxaban (38%), apixaban (28%), warfarin (25%), and dabigatran (9%). Permanent discontinuation or switches occurred in 55 participants (15%), and involved 25 discontinuations (rivaroxaban 10/133, dabigatran 2/33, apixaban 8/100, warfarin 5/91; no between-group differences) and 37 switches (between direct oral anticoagulants [DOACs] 10, DOAC to warfarin 11, warfarin to DOAC 16). The proportion self-reported adherent was 96% overall. Adherence was lower with apixaban (mean MMAS score 7.1) than warfarin (7.4) and rivaroxaban (7.4); p≤0.003 for both comparisons. Using the ACTS and TSQM II treatment satisfaction instruments, “global satisfaction” with OAC treatment overall was 72 (SD 13) /100 with no significant between-OAC differences after adjustment for multiple-comparisons. Satisfaction with rivaroxaban and dabigatran were significantly higher than all other OACs on the “convenience” subscale (p<0.001) and the “overall positive impact on your life” ACTS question, respectively (p=0.007). Self-reported adherence was lower among participants who later stopped OAC (5.8 vs 7.3 /8), as was global treatment satisfaction (53 vs. 73 /100), perceived effectiveness (52 vs. 70 /100), side effects satisfaction (84 vs. 98 /100), positive impact on life (1.7 vs. 2.5 /5) and perceived benefit (8.1 vs. 11.1 /15); all p-values <0.001. These effects remained highly significant when patients who switched medications were also included. Persistence with OAC therapy and self-reported adherence were high overall in AF clinic patients. Adherence was lower with apixaban than other OACs, patients considered rivaroxaban more convenient than other OACs, and dabigatran had the most positive impact on patients’ lives. Satisfaction and adherence were significantly worse in patients who later stopped or switched therapies, presenting a potential opportunity to identify patients at risk of stopping. Aligning OAC prescribing with patients’ therapy preferences may improve satisfaction, and therefore adherence, potentially leading to fewer strokes." @default.
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• W2892419993 date "2018-10-01" @default.
• W2892419993 modified "2023-09-25" @default.
• W2892419993 title "PERSISTENCE, SWITCHING, SELF-REPORTED ADHERENCE AND SATISFACTION WITH ANTICOAGULANT THERAPY IN ATRIAL FIBRILLATION CLINIC PATIENTS: RESULTS OF A LONG-TERM PROSPECTIVE COHORT STUDY" @default.
• W2892419993 doi "https://doi.org/10.1016/j.cjca.2018.07.380" @default.
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