title: Medication prescription and adherence disparities in non valvular atrial fibrillation patients: an Italian portrait from the ARAPACIS study.
abstract: Non-valvular atrial fibrillation (NVAF) represents a major health-care problem, needing an extensive and strict thrombosis prevention for stroke and cardiovascular (CV) disease risks. NVAF management guidelines recommend adequate antithrombotic and anti-atherosclerotic therapies. Medication adherence has been recognized as a pivotal element in health quality promotion and in the achievement of better clinical outcomes. We conducted a post-hoc analysis of the "Atrial fibrillation Registry for Ankle-brachial index Prevalence Assessment-Collaborative Italian Study (ARAPACIS)" with the aim of discerning differences in pharmacological management and medication adherence among NVAF Italian patients. Furthermore, data were analysed according to Italian geographical macro-regions (North, Center, South) to evaluate whether socioeconomic conditions might also influence medication adherence. Thus, we selected 1,366 NVAF patients that fulfilled the Morisky Medication Adherence Scale-4 items. Regional disparities in drug prescriptions were observed. In particular, in high-risk patients (CHA2DS2-VASc ≥2) oral anticoagulants were more prescribed in Northern and Center patients (61 and 60 %, respectively) compared to 53 % of high-risk Southern patients. Also, medication adherence showed a progressive decrease from North to South (78 vs. 60 %, p < 0.001). This disparity was independent of the number of drugs consumed for any reason, since prevalence of poly-therapy among the three macro-regions was similar. Our results show regional differences in NVAF patients' antithrombotic management and medication adherence, potentially reflecting well-known disparities in socioeconomic status among Italian regions. Future interventions promoting campaigns to global health-care education may be desirable to improve clinical outcomes in NVAF patients.
authors.affiliation: First Medical Clinic, Sapienza University of Rome, Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Raparelli
authors.forename: Marco
authors.initials: M
authors.lastname: Proietti
authors.forename: Carmelo
authors.initials: C
authors.lastname: Buttà
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Giosia
authors.forename: Domenico
authors.initials: D
authors.lastname: Sirico
authors.forename: Paolo
authors.initials: P
authors.lastname: Gobbi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Corrao
authors.forename: Giovanni
authors.initials: G
authors.lastname: Davì
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Vestri
authors.forename: Francesco
authors.initials: F
authors.lastname: Perticone
authors.forename: Gino Roberto
authors.initials: GR
authors.lastname: Corazza
authors.forename: Francesco
authors.initials: F
authors.lastname: Violi
authors.forename: Stefania
authors.initials: S
authors.lastname: Basili
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors
chemical_list: D000925:Anticoagulants