ArticleInternational journal of clinical pharmacy2024
Group-based trajectory modeling to identify adherence patterns for direct oral anticoagulants in Medicare beneficiaries with atrial fibrillation: a real-world study on medication adherence.
Article in International journal of clinical pharmacy, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The effect of pharmacist intervention on medication adherence measured with proportion of days covered: a systematic review and meta-analysis.International journal of clinical pharmacy · 2025Pooled it
- Factors associated with longitudinal hydroxyurea adherence trajectories among individuals with sickle cell disease in Texas Medicaid: A group-based trajectory modeling study.Therapeutic advances in hematology · 2026Article
- Investigating the Time-Varying Nature of Medication Adherence Predictors: An Experimental Approach Using Andersen's Behavioral Model of Health Services Use.Pharmacy (Basel, Switzerland) · 2025Article
- Prediction of long-term adherence to direct oral anti-coagulants in patients with atrial fibrillation using first-order Markov models.Frontiers in pharmacology · 2025Article
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Authors and funding
8 authors.
Funding
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Abstract
backgroundSuboptimal adherence to direct oral anticoagulants (DOACs) among atrial fibrillation (AF) patients remains currently a major concern due to the increased risk of cardiac and thromboembolic events.
aimTo identify longitudinal distinct trajectories of DOAC adherence and sociodemographic and clinical factors associated with each trajectory.
methodPatients with AF who were prescribed with DOAC from July 2016-December 2017 were identified among patients enrolled in the Medicare Advantage Plan. Patients were followed up for a year after the index date to calculate the monthly proportion of days covered (PDC). The monthly PDC was incorporated into the logistic group-based trajectory model to evaluate distinct patterns of adherence. A multinomial regression model was carried out to assess various predictors associated with each trajectory. Sub-group analysis was conducted among incident DOAC users.
resultsTotal of 1969 patients with AF, four distinct trajectories of adherence were selected: adherent 36.8%, gaps in adherence 9.3%, gradual decline in adherence 29.7%, and rapid decline in adherence 24.2%. Significant predictors associated with suboptimal adherence trajectories were age (75 years or older), gender (male vs female), low-income subsidy health plan, prevalent users, and presence of comorbidities. Among 933 incident users, three adherence trajectories were identified: adherent trajectory (31.8%), rapid decline in adherence (32.5%), and gradual decline in adherence (35.6%). The significant predictors among incident users were gender (male vs female), low-income subsidy health plan, HAS-BLED score ≥ 2, and presence of coronary artery disease.
conclusionAdherence to DOACs was suboptimal among the total population and incident users.
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