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Persistence with VKA treatment in newly treated atrial fibrillation patients: an analysis based on a large sample of 38,076 German patients

  • Pharmacoepidemiology and Prescription
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Abstract

Purpose

The aim of this study was to describe persistence with vitamin K antagonist (VKA) treatment in German atrial fibrillation (AF) patients and to identify factors which may be associated with early discontinuation of VKA therapy.

Methods

We did a retrospective cohort study based on an anonymized German claims dataset with VKA treatment-naïve AF patients, who received at least one VKA prescription. VKA therapy discontinuation was defined as a gap >180 days.

Results

We identified 38,076 VKA patients who started a VKA therapy (mean age 76.13 years; 56.08% female; mean CHA2DS2-VASc-Score 4.49; mean Charlson Comorbidity Index (CCI) 3.91). After four quarters since start of VKA treatment, 14,889 (39.10%) of observed patients had discontinued their VKA treatment (after eight quarters: 54.61%). Mean time until treatment discontinuation was 390.55 days. Risk of VKA discontinuation increased with the diagnosis of dementia within the first two quarters of VKA treatment [HR 1.35 (95% CI 1.29–1.40)], diagnosed alcohol or drug abuse in the baseline period [HR 1.25; 95% CI 1.18–1.33)], female gender [HR 1.08; 95% CI 1.05–1.10)], higher age (HR 1.03; 95% CI 1.03–1.03), higher CCI (HR 1.05; 95% CI 1.04–1.05), any prescription of NSAID (HR 1.07; 95% CI 1.04–1.10), and number of surgeries in the first two quarters of VKA treatment (HR 1.05; 95% CI 1.04–1.05). At least one yearly visit to a cardiologist since start of VKA treatment decreased the risk of non-persistence [HR 0.90; 95% CI 0.88–0.93] and a cancer diagnosis in the baseline period (HR 0.92; 95% CI 0.89–0.96).

Conclusion

Non-persistence related to VKA therapy is common in AF patients. Older more comorbid female patients as well as patients who face surgeries and who do not visit a cardiologist regularly face a higher therapy discontinuation risk.

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Acknowledgements

The authors would like to thank two anonymous reviewers for their valuable comments.

Author information

Authors and Affiliations

  1. Institut für Pharmakoökonomie und Arzneimittellogistik (IPAM), Hochschule Wismar, Germany

    Thomas Wilke & Antje Groth

  2. AOK PLUS, Dresden, Germany

    Andreas Fuchs & Ulf Maywald

  3. Boehringer Ingelheim Pharma GmbH & Co.KG, Ingelheim, Germany

    Matthias Pfannkuche

Authors
  1. Thomas Wilke
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  2. Antje Groth
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  4. Matthias Pfannkuche
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  5. Ulf Maywald
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Corresponding author

Correspondence to Thomas Wilke.

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Contributions of authors statement

All authors made substantial contributions to all of the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be submitted. Specifically, the main tasks the authors were engaged in were as follows:

TW and AG: project lead, participated in writing all parts of the paper, and statistical analysis.

UM and AF: conception/design of the study, data collection, validation of database, and interpretation of results in discussion section.

MP: conception/design of the study and interpretation of results in discussion section.

Funding

The study was funded by Boehringer Ingelheim Pharma GmbH, Germany. The study design, the collection/analysis of data, and the writing of the manuscript were done independently of the funding source.

Conflict of interest

Thomas Wilke has acted as consultant for Boehringer Ingelheim Pharma, Bayer, GSK, LEO Pharma, Novartis, Sanofi-Aventis, Bristol Myers Squibb, Pfizer, and other pharmaceutical companies. Antje Groth has no conflict of interest. Matthias Pfannkuche is employed by Boehringer Ingelheim Pharma (Germany). Ulf Maywald and Andreas Fuchs work for the insurance fund that provided the study data (AOK PLUS).

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Wilke, T., Groth, A., Fuchs, A. et al. Persistence with VKA treatment in newly treated atrial fibrillation patients: an analysis based on a large sample of 38,076 German patients. Eur J Clin Pharmacol 73, 1437–1447 (2017). https://doi.org/10.1007/s00228-017-2307-2

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  • DOI: https://doi.org/10.1007/s00228-017-2307-2

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