The treatment pattern and adherence to direct oral anticoagulants in patients with atrial fibrillation aged over 65
In this study, we aimed to assess the utilization pattern (potentially inappropriate dosing and concomitant use of contraindicated drugs) and adherence to direct oral anticoagulants (DOACs), including apixaban, dabigatran, and rivaroxaban, in patients with atrial fibrillation (AF) unsuitable for war...
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| description | In this study, we aimed to assess the utilization pattern (potentially inappropriate dosing and concomitant use of contraindicated drugs) and adherence to direct oral anticoagulants (DOACs), including apixaban, dabigatran, and rivaroxaban, in patients with atrial fibrillation (AF) unsuitable for warfarin.
We used nationally representative data, namely Health Insurance Review and Assessment Service-Aged Patient Sample 2014, that included medical and pharmacy claims of approximately 1 million patients aged 65 or older. We included patients who had at least one diagnosis of AF and at least one prescription of DOAC between January 1 and December 31, 2014. In 2014, DOACs were reimbursed only to patients with AF unsuitable for warfarin. Appropriate dosing and contraindicated drugs were determined according to the Summary of Product Characteristics for each DOAC. Multivariate logistic regression was performed to examine the factors contributing to the concomitant use of contraindicated drugs. To assess adherence, we calculated the medication possession ratio (MPR).
The percentage of inappropriate dosing was 11.8% among 1,234 patients with AF; it was the highest in rivaroxaban users (16.8%). Contraindicated drugs were prescribed to 236 patients (19.1%). Clinics, smaller healthcare institutions, and outpatient visits were significantly related to contraindicated drug use. The mean MPRs were 0.95, 0.93, and 0.91 for apixaban, dabigatran, and rivaroxaban, respectively (P = 0.075).
Careful monitoring is warranted in patients with AF aged over 65 who were unsuitable for warfarin to reduce the incidence of inappropriate dosing and concomitant use of contraindicated drugs. |
| doi_str_mv | 10.1371/journal.pone.0214666 |
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We used nationally representative data, namely Health Insurance Review and Assessment Service-Aged Patient Sample 2014, that included medical and pharmacy claims of approximately 1 million patients aged 65 or older. We included patients who had at least one diagnosis of AF and at least one prescription of DOAC between January 1 and December 31, 2014. In 2014, DOACs were reimbursed only to patients with AF unsuitable for warfarin. Appropriate dosing and contraindicated drugs were determined according to the Summary of Product Characteristics for each DOAC. Multivariate logistic regression was performed to examine the factors contributing to the concomitant use of contraindicated drugs. To assess adherence, we calculated the medication possession ratio (MPR).
The percentage of inappropriate dosing was 11.8% among 1,234 patients with AF; it was the highest in rivaroxaban users (16.8%). Contraindicated drugs were prescribed to 236 patients (19.1%). Clinics, smaller healthcare institutions, and outpatient visits were significantly related to contraindicated drug use. The mean MPRs were 0.95, 0.93, and 0.91 for apixaban, dabigatran, and rivaroxaban, respectively (P = 0.075).
Careful monitoring is warranted in patients with AF aged over 65 who were unsuitable for warfarin to reduce the incidence of inappropriate dosing and concomitant use of contraindicated drugs.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0214666</identifier><identifier>PMID: 30934004</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adhesion ; Administration, Oral ; Age Factors ; Aged ; Aged, 80 and over ; Analysis ; Anticoagulants ; Anticoagulants - administration & dosage ; Apixaban ; Atrial fibrillation ; Atrial Fibrillation - drug therapy ; Atrial Fibrillation - epidemiology ; Cardiac arrhythmia ; Codes ; Contraindications, Drug ; Dose-Response Relationship, Drug ; Drug dosages ; Drug screening ; Drug Substitution - statistics & numerical data ; Drug Utilization - statistics & numerical data ; Drugs ; Drugstores ; Embolisms ; Female ; Fibrillation ; Health care ; Health insurance ; Heart ; Humans ; Insurance ; Joint replacement surgery ; Male ; Medication Adherence - statistics & numerical data ; Medicine and Health Sciences ; Patient compliance ; Patients ; Pharmacy ; Practice Patterns, Physicians' - statistics & numerical data ; Republic of Korea - epidemiology ; Retrospective Studies ; Rivaroxaban ; Stroke ; Thrombosis ; Warfarin</subject><ispartof>PloS one, 2019-04, Vol.14 (4), p.e0214666-e0214666</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Han et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Han et al 2019 Han et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-587dddcce0b1a94f3d6bba4445466842d2953eb71a4a6c581c1c373fa4e8e0e23</citedby><cites>FETCH-LOGICAL-c692t-587dddcce0b1a94f3d6bba4445466842d2953eb71a4a6c581c1c373fa4e8e0e23</cites><orcidid>0000-0003-3445-6607</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443233/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443233/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30934004$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>ten Cate, Hugo</contributor><creatorcontrib>Han, Sola</creatorcontrib><creatorcontrib>Jeong, Hwa Seop</creatorcontrib><creatorcontrib>Kim, Hyungtae</creatorcontrib><creatorcontrib>Suh, Hae Sun</creatorcontrib><title>The treatment pattern and adherence to direct oral anticoagulants in patients with atrial fibrillation aged over 65</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>In this study, we aimed to assess the utilization pattern (potentially inappropriate dosing and concomitant use of contraindicated drugs) and adherence to direct oral anticoagulants (DOACs), including apixaban, dabigatran, and rivaroxaban, in patients with atrial fibrillation (AF) unsuitable for warfarin.
We used nationally representative data, namely Health Insurance Review and Assessment Service-Aged Patient Sample 2014, that included medical and pharmacy claims of approximately 1 million patients aged 65 or older. We included patients who had at least one diagnosis of AF and at least one prescription of DOAC between January 1 and December 31, 2014. In 2014, DOACs were reimbursed only to patients with AF unsuitable for warfarin. Appropriate dosing and contraindicated drugs were determined according to the Summary of Product Characteristics for each DOAC. Multivariate logistic regression was performed to examine the factors contributing to the concomitant use of contraindicated drugs. To assess adherence, we calculated the medication possession ratio (MPR).
The percentage of inappropriate dosing was 11.8% among 1,234 patients with AF; it was the highest in rivaroxaban users (16.8%). Contraindicated drugs were prescribed to 236 patients (19.1%). Clinics, smaller healthcare institutions, and outpatient visits were significantly related to contraindicated drug use. The mean MPRs were 0.95, 0.93, and 0.91 for apixaban, dabigatran, and rivaroxaban, respectively (P = 0.075).
Careful monitoring is warranted in patients with AF aged over 65 who were unsuitable for warfarin to reduce the incidence of inappropriate dosing and concomitant use of contraindicated drugs.</description><subject>Adhesion</subject><subject>Administration, Oral</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis</subject><subject>Anticoagulants</subject><subject>Anticoagulants - administration & dosage</subject><subject>Apixaban</subject><subject>Atrial fibrillation</subject><subject>Atrial Fibrillation - drug therapy</subject><subject>Atrial Fibrillation - epidemiology</subject><subject>Cardiac arrhythmia</subject><subject>Codes</subject><subject>Contraindications, Drug</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug dosages</subject><subject>Drug screening</subject><subject>Drug Substitution - statistics & numerical data</subject><subject>Drug Utilization - statistics & numerical data</subject><subject>Drugs</subject><subject>Drugstores</subject><subject>Embolisms</subject><subject>Female</subject><subject>Fibrillation</subject><subject>Health care</subject><subject>Health insurance</subject><subject>Heart</subject><subject>Humans</subject><subject>Insurance</subject><subject>Joint replacement surgery</subject><subject>Male</subject><subject>Medication Adherence - statistics & numerical data</subject><subject>Medicine and Health Sciences</subject><subject>Patient compliance</subject><subject>Patients</subject><subject>Pharmacy</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Republic of Korea - epidemiology</subject><subject>Retrospective Studies</subject><subject>Rivaroxaban</subject><subject>Stroke</subject><subject>Thrombosis</subject><subject>Warfarin</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk9-L1DAQx4so3nn6H4gWBNGHXdMkzTYvwnH4Y-HgQE9fQ5pMu1m6zZqkp_73Tt3esZV7kD4kZD7zzcw3nSx7XpBlwVbFu60fQq-75d73sCS04EKIB9lpIRldCErYw6P9SfYkxi0hJauEeJydMCIZJ4SfZvF6A3kKoNMO-pTvdUoQ-lz3Ntd2AwF6g3GfWxfApNwH3WEwOeN1O3S4i7nrxzQH4_6nS5tcp-AQa1wdXNdhyKNgCzb3NxByUT7NHjW6i_BsWs-ybx8_XF98XlxefVpfnF8ujJA0LcpqZa01BkhdaMkbZkVda855ia1WnFoqSwb1qtBcC1NWhSkMW7FGc6iAAGVn2cuD7r7zUU1-RUUpoWVFKsGQWB8I6_VW7YPb6fBbee3U3wMfWqUDNtuBYmzVlFiPsFZiBUwKzQ2VUICUpgaLWu-n24Z6B9agH2jWTHQe6d1Gtf5GCc4ZZWMxbyaB4H8MEJPauWgAHezBD4e6KSmYJIi--ge9v7uJajU24PrG471mFFXnI8LLikqklvdQ-FnY4TP30Dg8nyW8nSUgk-BXavUQo1p__fL_7NX3Ofv6iN2A7tIm-m4Y_584B_kBNMHHGKC5M7kgapyNWzfUOBtqmg1Me3H8QHdJt8PA_gD8aQrE</recordid><startdate>20190401</startdate><enddate>20190401</enddate><creator>Han, Sola</creator><creator>Jeong, Hwa Seop</creator><creator>Kim, Hyungtae</creator><creator>Suh, Hae Sun</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-3445-6607</orcidid></search><sort><creationdate>20190401</creationdate><title>The treatment pattern and adherence to direct oral anticoagulants in patients with atrial fibrillation aged over 65</title><author>Han, Sola ; Jeong, Hwa Seop ; Kim, Hyungtae ; Suh, Hae Sun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-587dddcce0b1a94f3d6bba4445466842d2953eb71a4a6c581c1c373fa4e8e0e23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adhesion</topic><topic>Administration, Oral</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis</topic><topic>Anticoagulants</topic><topic>Anticoagulants - administration & dosage</topic><topic>Apixaban</topic><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - drug therapy</topic><topic>Atrial Fibrillation - epidemiology</topic><topic>Cardiac arrhythmia</topic><topic>Codes</topic><topic>Contraindications, Drug</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug dosages</topic><topic>Drug screening</topic><topic>Drug Substitution - statistics & numerical data</topic><topic>Drug Utilization - statistics & numerical data</topic><topic>Drugs</topic><topic>Drugstores</topic><topic>Embolisms</topic><topic>Female</topic><topic>Fibrillation</topic><topic>Health care</topic><topic>Health insurance</topic><topic>Heart</topic><topic>Humans</topic><topic>Insurance</topic><topic>Joint replacement surgery</topic><topic>Male</topic><topic>Medication Adherence - statistics & numerical data</topic><topic>Medicine and Health Sciences</topic><topic>Patient compliance</topic><topic>Patients</topic><topic>Pharmacy</topic><topic>Practice Patterns, Physicians' - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Han, Sola</au><au>Jeong, Hwa Seop</au><au>Kim, Hyungtae</au><au>Suh, Hae Sun</au><au>ten Cate, Hugo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The treatment pattern and adherence to direct oral anticoagulants in patients with atrial fibrillation aged over 65</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-04-01</date><risdate>2019</risdate><volume>14</volume><issue>4</issue><spage>e0214666</spage><epage>e0214666</epage><pages>e0214666-e0214666</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>In this study, we aimed to assess the utilization pattern (potentially inappropriate dosing and concomitant use of contraindicated drugs) and adherence to direct oral anticoagulants (DOACs), including apixaban, dabigatran, and rivaroxaban, in patients with atrial fibrillation (AF) unsuitable for warfarin.
We used nationally representative data, namely Health Insurance Review and Assessment Service-Aged Patient Sample 2014, that included medical and pharmacy claims of approximately 1 million patients aged 65 or older. We included patients who had at least one diagnosis of AF and at least one prescription of DOAC between January 1 and December 31, 2014. In 2014, DOACs were reimbursed only to patients with AF unsuitable for warfarin. Appropriate dosing and contraindicated drugs were determined according to the Summary of Product Characteristics for each DOAC. Multivariate logistic regression was performed to examine the factors contributing to the concomitant use of contraindicated drugs. To assess adherence, we calculated the medication possession ratio (MPR).
The percentage of inappropriate dosing was 11.8% among 1,234 patients with AF; it was the highest in rivaroxaban users (16.8%). Contraindicated drugs were prescribed to 236 patients (19.1%). Clinics, smaller healthcare institutions, and outpatient visits were significantly related to contraindicated drug use. The mean MPRs were 0.95, 0.93, and 0.91 for apixaban, dabigatran, and rivaroxaban, respectively (P = 0.075).
Careful monitoring is warranted in patients with AF aged over 65 who were unsuitable for warfarin to reduce the incidence of inappropriate dosing and concomitant use of contraindicated drugs.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30934004</pmid><doi>10.1371/journal.pone.0214666</doi><tpages>e0214666</tpages><orcidid>https://orcid.org/0000-0003-3445-6607</orcidid><oa>free_for_read</oa></addata></record> |
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| issn | 1932-6203 1932-6203 |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adhesion Administration, Oral Age Factors Aged Aged, 80 and over Analysis Anticoagulants Anticoagulants - administration & dosage Apixaban Atrial fibrillation Atrial Fibrillation - drug therapy Atrial Fibrillation - epidemiology Cardiac arrhythmia Codes Contraindications, Drug Dose-Response Relationship, Drug Drug dosages Drug screening Drug Substitution - statistics & numerical data Drug Utilization - statistics & numerical data Drugs Drugstores Embolisms Female Fibrillation Health care Health insurance Heart Humans Insurance Joint replacement surgery Male Medication Adherence - statistics & numerical data Medicine and Health Sciences Patient compliance Patients Pharmacy Practice Patterns, Physicians' - statistics & numerical data Republic of Korea - epidemiology Retrospective Studies Rivaroxaban Stroke Thrombosis Warfarin |
| title | The treatment pattern and adherence to direct oral anticoagulants in patients with atrial fibrillation aged over 65 |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-07T06%3A28%3A51IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20treatment%20pattern%20and%20adherence%20to%20direct%20oral%20anticoagulants%20in%20patients%20with%20atrial%20fibrillation%20aged%20over%2065&rft.jtitle=PloS%20one&rft.au=Han,%20Sola&rft.date=2019-04-01&rft.volume=14&rft.issue=4&rft.spage=e0214666&rft.epage=e0214666&rft.pages=e0214666-e0214666&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0214666&rft_dat=%3Cgale_plos_%3EA580845829%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2202580863&rft_id=info:pmid/30934004&rft_galeid=A580845829&rft_doaj_id=oai_doaj_org_article_337f5ddd6dd9454396a4c29e1e99cbed&rfr_iscdi=true |