Dabigatran adherence in atrial fibrillation patients during the first year after diagnosis: a nationwide cohort study
Dabigatran adherence in atrial fibrillation patients during the first year after diagnosis: a nationwide cohort study
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DOI：
10.1111/jth.12845
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发表时间：
2015-04-01
影响因子：
10.4
通讯作者：
Lane, D. A.
中科院分区：
文献类型：
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作者：
Gorst-Rasmussen, A.;Skjoth, F.;Lane, D. A.
背景医生们普遍认为，缺乏对非维生素K拮抗剂口服抗凝剂（NOAC）的常规监测可能导致药物依从性差。我们研究了一个新诊断的非瓣膜性房颤（AF）患者队列中开始使用NOAC，达比加群酯（dabigatran etexilate.Methods and resultsNationwide丹麦患者和处方购买登记处的第一年的依从性，以确定新诊断的AF患者服用达比加群，合并症，并根据每日两次，一丸方案的再填充模式。使用覆盖天数比例（PDC）、间隔率和重新开始率对1年后剩余使用者（N=2960）的依从性进行表征。总体1年PDC为83.9%，76.8%的患者1年PDC超过80%。CHA（2）DS（2）-VASc评分为2的患者比CHA（2）DS（2）-VASc评分为1的患者对药物治疗方案的依从性更高（PDC比率，1.12; 95%置信区间[CI]，1.08-1.17），一般而言，发病率较高的患者表现出更高的依从性。既往出血患者对药物治疗方案的依从性不低于既往无出血患者（PDC比，1.02; 95% CI，0.98-1.06）。总体差距率为每年1.4个差距。亚组之间的差距率没有明显的趋势，虽然发病率较高的患者往往有稍微多，但较短，gap periods.ConclusionsMore的75%以上的患者表现出>80%坚持服药制度在第一年。发病率较高的患者，包括卒中或出血风险较高的患者，表现出更好的依从性。这一改善可能是由于与医疗保健系统的联系更加频繁。
BackgroundThere is a perception among physicians that lack of routine monitoring with non-vitamin K antagonist oral anticoagulants (NOACs) may lead to poor adherence to medication. We studied adherence during the first year of usage in a cohort of patients with newly diagnosed non-valvular atrial fibrillation (AF) started on the NOAC, dabigatran etexilate.Methods and resultsNationwide Danish patient and prescription purchase registries were used to identify newly diagnosed AF patients taking dabigatran, comorbidities, and refill patterns under a twice-daily, one pill regimen. Adherence was characterized among remaining users (N=2960) after 1year using the proportion of days covered (PDC), gap rates and restart rates. The overall 1-year PDC was 83.9%, with 76.8% of patients having a 1-year PDC in excess of 80%. Patients with a CHA(2)DS(2)-VASc score 2 were more adherent to medication regimes than patients with a CHA(2)DS(2)-VASc score of 1 (PDC ratio, 1.12; 95% confidence interval [CI], 1.08-1.17) and generally patients with higher morbidity showed more adherence. Patients with prior bleeding were not less adherent to medication regimes than patients with no prior bleeding (PDC ratio, 1.02; 95% CI, 0.98-1.06). The overall gap rate was 1.4 gaps per year. There were no clear tendencies in gap rates among subgroups, although patients with higher morbidity tended to have slightly more, but shorter, gap periods.ConclusionsMore than 75% of patients were showed >80% adherence to medication regimes during the first year. Patients with higher morbidity, including patients with a higher risk of stroke or bleeding, exhibited better adherence. This improvement may be attributable to more regular contact with the healthcare system.