There is a general lack of studies evaluating medication adherence with self-report scales for elderly patients in treatment with direct oral anticoagulants (DOACs). The aim of the study was to assess the degree of adherence to DOAC therapy in a population of elderly outpatients aged 65 years or older affected by non-valvular atrial fibrillation (NVAF), using the 4-item Morisky Medication Adherence Scale, and to identify potential factors, including the geriatric multidimensional evaluation, which can affect adherence in the study population. A total of 103 subjects, anticoagulated with DOACs for NVAF in primary or secondary prevention, were eligible; 76 showed adequate adhesion to anticoagulant therapy, while 27 showed inadequate adherence. Participants underwent biochemical assessment and Morisky Scale, Instrumental Activities of Daily Living, CHA2DS2-VASc, HAS-BLED, mental status and nutritional evaluations were performed. 2% of subjects assumed Dabigatran at low dose, while 7.8% at standard dose, 9.7% assumed low-dose of Rivaroxaban and 30.1% at standard dose, 6.8% assumed Apixaban at low dose and 39.7% at standard dose, and finally 1% assumed Edoxaban at low dose and 2.9% at standard dose. Most subjects took the DOACs without help (80.6%), while 16 subjects were helped by a family member (15.5%) and 4 were assisted by a caregiver (3.9%). Binary logistic regression considered inappropriate adherence as a dependent variable, while age, male sex, polypharmacotherapy, cognitive decay, caregiver help for therapy assumption, duration of DOAC therapy and double daily administration were considered as independent variables. The double daily administration was an independent factor, determining inappropriate adherence with an OR of 2.88 (p = 0.048, CI 1.003–8.286).
Atrial fibrillation Direct anticoagulants Adherence Elderly
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The authors’ responsibilities were as follows—AR, RF, EF: analysis and interpretation of data and preparation of manuscript; EZ, FF, MZ: edited the manuscript, AR, RF, EF, SS, NN, EM, FF, GM: study concept and design, acquisition of subjects, collection of data, and review of the manuscript. The manuscript has been revised extensively by a native English speaker and medical writer, Prof. Mark J Newman.
Zirlik A, Bode C (2017) Vitamin K antagonists: relative strengths and weaknesses vs. direct oral anticoagulants for stroke prevention in patients with atrial fibrillation. J Thromb Thrombolysis 43:365–379CrossRefPubMedGoogle Scholar
Khan F, Huang H, Datta YH (2016) Direct oral anticoagulant use and the incidence of bleeding in the very elderly with atrial fibrillation. J Thromb Thrombolysis 42:573–578CrossRefPubMedPubMedCentralGoogle Scholar
Morisky DE, Green LW, Levine DM (1986) Concurrent and predictive validity of self-reported measure of medication adherence. Med Care 24(1):67–74CrossRefPubMedGoogle Scholar
Davis NJ, Billett HH, Cohen HW, Arnsten JH (2005) Impact of adherence, knowledge, and quality of life on anticoagulation control. Ann Pharmacother 39(4):632–636CrossRefPubMedGoogle Scholar
Wang Y, Kong MC, Ko Y (2013) Comparison of three medication adherence measures in patients taking warfarin. J Thromb Thrombolysis 36(4):416–421CrossRefPubMedGoogle Scholar
Castellucci LA, Shaw J, van der Salm K, Erkens P, Le Gal G, Petrcich W et al (2015) Self-reported adherence to anticoagulation and its determinants using the Morisky medication adherence scale. Thromb Res 136:727–731CrossRefPubMedGoogle Scholar
Drouin L, Gegu M, Mahe J, de Decker L, Berrut G, Chevalet P (2017) Oral anticoagulants adherence in elderly patients treated for atrial fibrillation in the era of direct oral anticoagulants. Ann Cardiol Angeiol 66:197–203CrossRefGoogle Scholar
Pfeiffer E (1975) A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 23:433–441CrossRefPubMedGoogle Scholar
Sheikh J, Yesavage J (1986) Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol 5:165–173CrossRefGoogle Scholar
Katz S (1983) Assessing self-maintenance activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 31:721–727CrossRefPubMedGoogle Scholar
Guigoz Y, Vellas B (1999) The Mini Nutritional Assessment (MNA) for grading the nutritional state of elderly patients: presentation of the MNA, history and validation. Nestle Nutr Workshop Ser Clin Perform Program 1:3–11CrossRefGoogle Scholar
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMedGoogle Scholar
Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ (2010) Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on atrial fibrillation. Chest 137:263–272CrossRefPubMedGoogle Scholar
Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY (2010) A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 138:1093–1100CrossRefPubMedGoogle Scholar
Cockroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41CrossRefGoogle Scholar
Claxton AJ, Cramer J, Pierce C (2001) A systematic review of the associations between dose regimens and medication compliance. Clin Ther 23:1296–1310CrossRefPubMedGoogle Scholar
Sørensen R, Jamie Nielsen B, Langtved Pallisgaard J, Ji-Young Lee C, Torp-Pedersen C (2017) Adherence with oral anticoagulation in non-valvular atrial fibrillation: a comparison of vitamin K antagonists and non-vitamin K antagonists. Eur Heart J Cardiovasc Pharmacother 3:151–156CrossRefPubMedGoogle Scholar
Beyer-Westendorf J, Ehlken B, Evers T (2016) Real-world persistence and adherence to oral anticoagulation for stroke risk reduction in patients with atrial fibrillation. Europace 18:1150–1157CrossRefPubMedGoogle Scholar
McHorney CA, Peterson ED, Laliberté F, Germain G, Nelson WW, Crivera C et al (2016) Comparison of adherence to rivaroxaban versus apixaban among patients with atrial fibrillation. Clin Ther 38:2477–2488CrossRefPubMedGoogle Scholar