Observational studyEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2021
Persistence and adherence to non-vitamin K antagonist oral anticoagulant treatment in patients with atrial fibrillation across five Western European countries.
Observational study in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 37 citations in OpenAlex.
- Adherence and persistence with direct oral anticoagulants by dose regimen: A systematic review.British journal of clinical pharmacology · 2025Pooled it
- Mental Health Conditions and Nonpersistence of Direct Oral Anticoagulant Use in Patients With Incident Atrial Fibrillation: A Nationwide Cohort Study.Journal of the American Heart Association · 2022Trial
- Implementation of novel antithrombotic treatment strategies and outcome improvements in patients with myocardial infarction and atrial fibrillation over 20 years: a nationwide cohort study.European heart journal. Cardiovascular pharmacotherapy · 2026Article
- Compliance to direct oral anticoagulation therapy and clinical outcomes after catheter ablation for atrial fibrillation: a nationwide cohort study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026Article
- Oral Anticoagulant Therapy of Patients With Atrial Fibrillation in Cardiology, Internal Medicine, and Surgery: Temporal Trend.MedComm · 2025Article
- Reasons for omitting anticoagulant treatment in patients with atrial fibrillation: an audit of patient records in general practice.BMC primary care · 2025Article
- Edoxaban treatment in routine clinical practice is highly concordant with the 2020 European Society of Cardiology atrial fibrillation guidelines: results from the noninterventional Global ETNA-AF programme.European heart journal open · 2025Article
- Electronic Monitoring of Medication Adherence to Direct Oral Anticoagulants: A Systematic Review.Patient preference and adherence · 2025Review
- Antithrombotic Treatment and Clinical Outcomes After Intracerebral Hemorrhage: A Retrospective Cohort Study from the Swedish Stroke Register.Journal of the American Heart Association · 2024Article
- Adherence to oral anticoagulation measured by electronic monitoring in a Belgian atrial fibrillation population.Clinical research in cardiology : official journal of the German Cardiac Society · 2023Article
- Lifeday coverage of oral anticoagulants and one-year relative survival in patients with atrial fibrillation: a population-based study in Estonia.BMC cardiovascular disorders · 2023Article
- Prevalence and Predictors of Nonadherence to Direct Oral Anticoagulant Treatment in Patients with Atrial Fibrillation.TH open : companion journal to thrombosis and haemostasis · 2023Article
- In atrial fibrillation epilepsy risk differs between oral anticoagulants: active comparator, nested case-control study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Article
- Article
- Poor adherence to guideline-directed anticoagulation in elderly Chinese patients with atrial fibrillation: a report from the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry.European heart journal. Quality of care & clinical outcomes · 2023Article
- Bleeding events among patients concomitantly treated with direct oral anticoagulants and macrolide or fluoroquinolone antibiotics.British journal of clinical pharmacology · 2023Article
- Trends in population-based incidence, diagnostics, and mortality of acute superior mesenteric artery occlusion.Frontiers in surgery · 2023Article
- Risk Profiles of New Users of Oral Anticoagulants Between 2011 and 2019 in Germany.Clinical epidemiology · 2023Article
- Determinants of the Empiric Use of Antibiotics by General Practitioners in South Africa: Observational, Analytic, Cross-Sectional Study.Antibiotics (Basel, Switzerland) · 2022Article
- Pandemic-proof recruitment and engagement in a fully decentralized trial in atrial fibrillation patients (DeTAP).NPJ digital medicine · 2022Article
Corrections and comments
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Authors and funding
18 authors at 9 institutions in 6 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsTo assess persistence and adherence to non-vitamin K antagonist oral anticoagulant (NOAC) treatment in patients with atrial fibrillation (AF) in five Western European healthcare settings. METHODS AND
resultsWe conducted a multi-country observational cohort study, including 559 445 AF patients initiating NOAC therapy from Stockholm (Sweden), Denmark, Scotland, Norway, and Germany between 2011 and 2018. Patients were followed from their first prescription until they switched to a vitamin K antagonist, emigrated, died, or the end of follow-up. We measured persistence and adherence over time and defined adequate adherence as medication possession rate ≥90% among persistent patients only.
resultsOverall, persistence declined to 82% after 1 year and to 63% after 5 years. When including restarters of NOAC treatment, 85% of the patients were treated with NOACs after 5 years. The proportion of patients with adequate adherence remained above 80% throughout follow-up. Persistence and adherence were similar between countries and was higher in patients starting treatment in later years. Both first year persistence and adherence were lower with dabigatran (persistence: 77%, adherence: 65%) compared with apixaban (86% and 75%) and rivaroxaban (83% and 75%) and were statistically lower after adjusting for patient characteristics. Adherence and persistence with dabigatran remained lower throughout follow-up.
conclusionPersistence and adherence were high among NOAC users in five Western European healthcare settings and increased in later years. Dabigatran use was associated with slightly lower persistence and adherence compared with apixaban and rivaroxaban.
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