NOAC Adherence of Patients with Atrial Fibrillation in the Real World: Dosing Frequency Matters?

Jongmin Hwang; Seongwook Han; Han-Joon Bae; Seung-Woon Jun; Sang-Woong Choi; Cheol-Hyun Lee; In-Cheol Kim; Yun-Kyeong Cho; Hyoung-Seob Park; Hyuck-Jun Yoon; Hyungseop Kim; Chang-Wook Nam; Seung-Ho Hur; Sang-Hoon Lee

doi:10.1055/s-0039-1697954

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2020; 120(02): 306-313
DOI: 10.1055/s-0039-1697954

Stroke, Systemic or Venous Thromboembolism

Georg Thieme Verlag KG Stuttgart · New York

NOAC Adherence of Patients with Atrial Fibrillation in the Real World: Dosing Frequency Matters?

Jongmin Hwang

¹Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea

,

Seongwook Han

¹Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea

,

Han-Joon Bae

²Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, South Korea

,

Seung-Woon Jun

¹Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea

,

Sang-Woong Choi

¹Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea

,

Cheol-Hyun Lee

¹Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea

,

In-Cheol Kim

¹Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea

,

Yun-Kyeong Cho

¹Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea

,

Hyoung-Seob Park

¹Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea

,

Hyuck-Jun Yoon

¹Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea

,

Hyungseop Kim

¹Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea

,

Chang-Wook Nam

¹Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea

,

Seung-Ho Hur

¹Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea

,

Sang-Hoon Lee

³Division of Cardiology, Department of Internal Medicine, SM Christianity Hospital, Pohang, South Korea

› Author Affiliations

Abstract

Background and Objectives Nonvitamin K antagonist oral anticoagulants (NOACs) require stricter medication adherence. We investigated the NOACs adherence in real-world practice.

Methods We screened all patients in our cardiology department the day before their outpatient appointment, over a 5-month period. We enrolled 719 consecutive patients who were taking NOACs for atrial fibrillation. The patients were contacted by phone or text to bring the remnant pills with them without any information why. Adherence was measured by the percentage of prescribed doses taken (PDT) (number of doses taken/number of doses expected to be taken from the last prescription × 100 [%]) and the Morisky Medication Adherence Scale (MMAS)-8.

Results All 4 NOACs (apixaban 47.8%, dabigatran 21.2%, rivaroxaban 18.4%, and edoxaban 12.6%) were prescribed. The mean duration that the patients had been taking NOACs was 7.2 ± 5.7 months. The PDT was 95.4 ± 9.1% in the once-daily dosing group and 93.4 ± 12.7% in the twice-daily group, and the difference was statistically significant (p = 0.017). The mean MMAS was 2.6 ± 0.8. The proportion of patients with a PDT < 80% was 7.8%. They had a significantly higher MMAS than the PDT ≥ 80% group (3.4 vs. 2.5; p = 0.000).

Conclusion Most patients who were taking NOACs had excellent adherence regardless of the dosing frequency. An MMAS ≥ 3 could be used as a simple screening tool for a poor NOAC adherence.

Keywords

medication adherence - anticoagulant - atrial fibrillation

Full Text

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Supplementary Material

Supplementary Material