Author + information
- Laurent Fauchier,
- Shuk-Li Collings,
- Michelle Johnson,
- Gillian Stynes,
- David Evans,
- Virginie Vannier-Moreau,
- Guido Hack,
- Matthew Lumley,
- Andrew Maguire,
- Cinira Lefevre and
- Bristol-Myers Squibb
Background: Discontinuation of oral anticoagulant (OAC) therapy in patients with non-valvular atrial fibrillation (NVAF) leaves patients unprotected from risk of stroke. We investigated OAC treatment persistence in NVAF in primary care of 3 European countries.
Methods: Three cohorts of patients with NVAF newly prescribed OACs (i.e. no prior OAC therapy) between 1-Dec-12 and 31-Oct-14 in UK (Clinical Practice Research Datalink) and Germany (DE) (IMS LifeLink) and 1-Jan-14 and 31-Jan-16 in France (FR) (IMS Longitudinal Patient Database). We used Cox models to compare non-persistence (discontinuation/switch) across OACs. Time-partitioned modelling was used where hazards were non-proportional (UK, 60 days; DE, 100 days; FR, not necessary).
Results: Of a total of 27448 patients (16235 VKA, 6948 rivaroxaban, 2351 dabigatran, 1914 apixaban), 6-month persistence varied across countries; overall dabigatran had the lowest persistence, and apixaban and VKA the highest (UK 74.2% dabigatran, 80.7% rivaroxaban, 88.2% apixaban, 87.0% VKA; DE 59.8%, 67.3%, 71.6%, 71.1% respectively; FR 56.6%, 60.0%, 63.0%, 67.7%). There were consistent differences in characteristics by OAC, e.g. apixaban patients had higher rates of cardiovascular comorbidities. Adjusting for these, compared to VKA, non-persistence was higher with rivaroxaban (UK hazard ratio 1.54, 95% confidence interval 1.35-1.76; DE 1.21, 1.14-1.29; FR 1.28, 1.13-1.45) and dabigatran (UK 1.83, 1.56-2.14; DE 1.53, 1.40-1.68; FR 1.42, 1.20-1.69). Apixaban non-persistence was similar to VKA (UK 1.09, 0.81-1.47; DE 1.08, 0.95-1.24; FR 1.12, 0.96-1.32). In time-partitioned analyses, in the later period, apixaban non-persistence was lower than VKA in UK (0.59, 0.38-0.92) and DE (0.66, 0.52-0.85).
Conclusions: Across 3 European countries, persistence to apixaban appears similar to VKA; however, there was greater persistence to apixaban than VKA after 60-100 days (UK and DE). Non-persistence was higher with rivaroxaban and dabigatran compared to VKA. These differences may impact effectiveness of OAC regimes in routine care. Findings reflect the early period after apixaban was introduced; research with longer follow-up is warranted.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Innovative Approaches for Reducing Risk and Improving Outcomes With Ablation
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1237-105
- 2017 American College of Cardiology Foundation