The use and adherence of oral anticoagulants in Primary Health Care in Catalunya, Spain: A real-world data cohort study
Por:
Giner-Soriano, M, Cortes, J, Gomez-Lumbreras, A, Prat-Vallverdu, O, Quijada-Manuitt, MA, Morros, R
Publicada:
1 oct 2020
Resumen:
Objective: We aimed to describe sociodemographic, comorbidities, co-medication and risk of thromboembolic events and bleeding in patients with NVAF initiating oral anticoagulants (OAC) for stroke prevention, and to estimate adherence and persistence to OAC.
Setting: Primary Health Care (PHC) in the Catalan Health Institute (ICS), Catalunya, Spain.
Participants: All NVAF adult patients initiating OAC for stroke prevention in August 2013-December 2015.
Methods: Population-based cohort study. Persistence was measured in patients initiating OAC in August 2013-December 2014.
Data source: SIDIAP, which captures electronic health records from PHC in the (ICS), covering approximately 5.8 million people.
Results: 51,690 NVAF patients initiated OAC; 47,197 (91.3%) were naive to OAC and 32,404 (62.7%) initiated acenocoumarol. Mean age was 72.8 years (SD 12.3) and 49.4% were women. Platelet-aggregation inhibitors were taken by 9105 (17.6%) of the patients. Persistence and adherence were estimated up to the end of follow-up. For 22,075 patients, persistence was higher among the non-naive patients [n = 258 (61.7%)] than among the naive [n = 11,502 (53.1%)]. Adherence was estimated for patients initiating DOAC and it was similar in naive and non-naive patients. Among the naive to DOAC treatment, those starting rivaroxaban showed a highest proportion [(n = 360 (80.1%)] of good adherence at implementation (MPR > 80%) while patients starting dabigatran were less adherent [n=203 (47.8%)].
Conclusions: Acenocoumarol was the most frequently prescribed OAC as first therapy in NVAF patients. Non-naive to DOAC showed better persistence than naive. Rivaroxaban showed higher proportion of adherent patients during the implementation phase than apixaban and dabigatran the lowest. (C) 2020 The Authors. Published by Elsevier Espana, S.L.U.
Filiaciones:
Giner-Soriano, M:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Barcelona, Spain
Univ Autonoma Barcelona, Bellaterra, Cerdanyola Del, Spain
Inst Catala Salut, Dept Salut, Generalitat Catalunya, Barcelona, Spain
Cortes, J:
Univ Politecn Cataluna, Dept Estadist & Invest Operat, Barcelona, Spain
Gomez-Lumbreras, A:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Barcelona, Spain
Univ Autonoma Barcelona, Bellaterra, Cerdanyola Del, Spain
Univ Girona, Fac Med, Dept Ciencies Med, Girona, Spain
Prat-Vallverdu, O:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Barcelona, Spain
Univ Autonoma Barcelona, Bellaterra, Cerdanyola Del, Spain
Quijada-Manuitt, MA:
Hosp Santa Creu & Sant Pau, Dept Clin Pharmacol, Barcelona, Spain
Univ Barcelona, Hosp Barcelona, Dept Pathol & Expt Therapeut, Unitat Docent Campus Bellvitge, Barcelona, Spain
Morros, R:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Barcelona, Spain
Univ Autonoma Barcelona, Bellaterra, Cerdanyola Del, Spain
Inst Catala Salut, Dept Salut, Generalitat Catalunya, Barcelona, Spain
Plataforma SCReN, UICEC IDIAP Jordi Gol, Barcelona, Spain
Gold, Green Published
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