Clinical InvestigationElectrophysiologyAdherence to dabigatran therapy and longitudinal patient outcomes: Insights from the Veterans Health Administration
Section snippets
Study design, setting and population
This is a retrospective cohort study of patients receiving health care in the VA between October 1, 2010 and September 30, 2012. We included all patients who filled a dabigatran prescription of at least 30 days duration at a VA pharmacy and had at least 30 days of follow-up. During this time, the criteria for dabigatran use were based on national, standardized VA Pharmacy Benefits Management criteria8 which included patients with non-valvular atrial fibrillation and a CHADS2 or CHA2DS2-VASc
Baseline characteristics
We initially identified 6,335 patients receiving at least one new dabigatran prescription between October 1, 2010 and September 30, 2012 (Figure 2). After applying our eligibility criteria, 959 (15.1%) patients with less than 30 days of follow-up and/or less than 30 days of medication fill were excluded. A total of 5,376 (84.9%) patients were included in the final study cohort with a median follow-up period of 244 days (IQR 140 - 351) and median of 5 refills (IQR 2-8) in the first year of
Discussion
The objective of this study was to describe adherence and its association with clinical outcomes in a national cohort of Veterans treated with dabigatran. We found that in patients with non-valvular atrial fibrillation, adherence to dabigatran in the first year was good for a majority of patients. However, more than one-quarter of patients had sub-optimal adherence to dabigatran and poor adherence was associated with an increased risk for stroke and all-cause mortality. There was no association
Disclaimer
The views expressed in this article are those of the authors and do not represent the United States government.
Disclosures
Funding sources: No funding agencies were involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, and approval of the manuscript.
Conflicts of Interest disclosures: Drs. Bradley, Turakhia and Maddox are supported by Career Development Awards from Veterans Affairs Health Services Research & Development. All the other authors report no relevant disclosures.
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