A Multicenter, Large-Scale Real-World Survey on Medication Adherence to Direct Oral Anticoagulants in Patients with Non-Valvular Atrial Fibrillation

Abstract

Excellent medication adherence to direct oral anticoagulants (DOAC) is crucial for the prognostic improvement of patients with non-valvular atrial fibrillation (NVAF). However, the level of medication adherence to DOAC and factors affecting medication adherence are not fully understood in Japanese patients in real-world clinical practice.

To assess medication adherence, this study enrolled 817 NVAF outpatients who took DOAC in 16 hospitals. Hospital pharmacists investigated the medication adherence by pill count and evaluated the patients’ knowledge about disease and medication.

The percentage of prescribed pills taken was 97.49 ± 6.728％, indicating an excellent medication adherence to DOAC. The proportion of non-adherence patients by definition 1 (percentage of prescribed pills taken < 90％ or no visit by the day after reaching the prescription days) was 8.9％ and that by definition 2 (definition 1 + did not bring unconsumed drugs) was 19.3％. Regarding the levels of patients’ knowledge about disease and medication, approximately 20％ of patients had no awareness of NVAF and 30％ of patients did not understand the purpose of their medication. Additionally, several factors associated with non-adherence were identified by the multivariate binary logistic regression analysis. A common factor between the non-adherence by definition 1 and definition 2 was the low level of knowledge about medication．

This study demonstrated that Japanese NVAF patients who were taking DOAC had excellent adherence. However, it is suggested that pharmacists strengthen the intervention especially for patients with a low level of medication knowledge, which may lead to further improvement of medication adherence to DOAC.