UCL Institute of Health Informatics


Adherence and persistence to direct anticoagulants in atrial fibrillation-Heart BMJ

21 October 2019

Researchers have had their work exploring the adherence and persistence to atrial fibrillation therapies published by the Heart BMJ.

Generic drugs in palm of a hand

Atrial fibrillation is the most common arrhythmia globally and is a major risk factor for stroke. The treatment is anticoagulation and the advent of four direct anticoagulants in addition to warfarin has given clinicians and patients choices for therapy which can improve outcomes. However, adherence (whether drugs are taken as prescribed) and persistence (whether drugs are continued) have not been studied across all drugs together. Dr Ami Banerjee and colleagues from Birmingham and University of Lancashire (funded by European Research Council), used the THIN database which includes longitudinal, anonymised electronic health records from over 500 UK general practices, representative of the UK population, to show that both adherence and persistence to direct anticoagulants is suboptimal, even at one year, despite the fact that these drugs have a lifelong indication. For drugs to be effective, both adherence and persistence are prerequisites. It is therefore concerning that adherent persistence at 1 year after initial prescription ranged from only 38.2% to 50.7% for Vitamin K antagonists (VKA) and apixaban, two anticoauglants, respectively. Electronic health records may represent a practical and feasible way of monitoring and predicting adherence and persistence to these important drugs in atrial fibrillation, with implications for drugs in other diseases.

Kaplan-Meier analysis of persistence over time. OAL is oral anticoagulant; VKA, is vitamin K antagonist.

To read the full paper, follow this link to the Heart BMJ website: https://heart.bmj.com/content/early/2019/10/10/heartjnl-2019-315307

Paper's full citation: Banerjee A, Benedetto V, Gichuru P, et al. Adherence and persistence to direct oral anticoagulants in atrial fibrillation: a population-based study. Heart Published Online First: 10 October 2019. doi: 10.1136/heartjnl-2019-315307