Oral Anticoagulant Prescription Trends, Profile Use, and Determinants of Adherence in Patients with Atrial Fibrillation
Oral Anticoagulant Prescription Trends, Profile Use, and Determinants of Adherence in Patients with Atrial Fibrillation
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DOI：
10.1002/phar.2350
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发表时间：
2019-12-17
期刊：
影响因子：
4.1
通讯作者：
Tardif, Jean-Claude
中科院分区：
文献类型：
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作者：
Perreault, Sylvie;de Denus, Simon;Tardif, Jean-Claude
背景和目的关于口服抗凝剂(OAC)摄取和使用模式的数据有限。房颤(房颤)患者的真实数据对于了解患者暴露情况很重要。建立了一项针对OAC新使用者的队列研究，以评估2011至2017年的药物使用趋势、持续率、转化率、依从性水平以及依从性的预测因素。方法我们使用魁北克疾病登记处(RAMQ)和Med-Echo管理数据库，对确诊为房颤的新成年OAC患者入院后1年内建立队列。OAC的新用户被定义为在进入队列之前的一年内没有OAC索赔。我们评估了OAC的使用趋势；持续率，定义为补药之间的差距不超过先前处方持续时间的两倍；以及依从性水平，定义为开始治疗后一年内覆盖的天数比例(PDC)。用Logistic回归模型分析不依从性(PDC<80%)的预测因素。结果队列由33,311名OAC事件使用者组成。在OAC索赔总额中，华法林索赔占比从2011年的77.9%下降到2017年的12.7%，其中直接口服抗凝剂(DOAC)占索赔的87.3%，截至2017年底，阿匹沙班和利伐沙班分别占60.1%和23.4%。OAC开始一年后，华法林组的持续率为53%，大剂量阿匹沙班组的持续率为77%。大约75%的事件OAC用户被认为是“依附者”(PDC 80%或更高)，平均PDC为95.6-98.1%，而“不依从者”的平均PDC在43.1%和50.7%之间。年龄较大、女性、较高的CHA(2)DS(2)-VASc评分(用于预测房颤的血栓栓塞性风险)、既往中风和接受慢性心血管疾病药物治疗与高依从性水平相关。结论DOAC的临床应用随时间推移而增加，占2017年处方的87.3%。在我们的研究中，25%的新OAC用户表现出较低的依从性水平。房颤患者对OAC的坚持仍然是一个巨大的挑战。
Background and Purpose Data on oral anticoagulant (OAC) uptake and pattern of use are limited. Real-life data in patients with atrial fibrillation (AF) are important for understanding patient exposure. A cohort study of new OAC users was built to assess trends of drug use from 2011 to 2017, persistence rate, switching rate, adherence level, and predictors of adherence. Methods We built a cohort using the Regie d'Assurance Maladie du Quebec (RAMQ) and Med-Echo administrative databases of new adult OAC users within 1 year following hospitalization with a diagnosis of AF. New users of OAC were defined as having no OAC claims in the year before cohort entry. We assessed trends of OAC use; persistence rate, defined as a gap between refills of no longer than two times the duration of the previous prescriptions; and adherence level, defined as the proportion of days covered (PDC) over a 1-year period following initiation. Predictors of nonadherence (PDC less than 80%) were analyzed using logistic regression models. Results The cohort consisted of 33,311 incident OAC users. Of total OAC claims, the proportions of warfarin claims decreased from 77.9% in 2011 to 12.7% in 2017, with direct oral anticoagulants (DOACs) accounting for 87.3% of claims, of which apixaban and rivaroxaban accounted for 60.1% and 23.4%, respectively, by the end of 2017. One year after OAC initiation, persistence rates ranged from 53% with warfarin to 77% with a high dose of apixaban. Approximately 75% of incident OAC users were considered "adherent" (PDC 80% or more), with a mean PDC of 95.6-98.1%, compared with "nonadherent," with a mean PDC varying between 43.1% and 50.7%. Older age, female sex, higher CHA(2)DS(2)-VASc score (to predict thromboembolic risk in AF), prior stroke, and treatment with chronic cardiovascular disease drugs were associated with high adherence levels. Conclusion The clinical uptake of DOACs increased over time, accounting for 87.3% of prescriptions in 2017. In our study, 25% of new OAC users presented a low adherence level. Adherence to OACs remains a significant challenge in patients with AF.