title: Improved persistence with non-vitamin-K oral anticoagulants compared with warfarin in patients with atrial fibrillation: recent Australian experience.
abstract: Long-term anticoagulant therapy in patients with non-valvular atrial fibrillation (AF) is essential to prevent thromboembolic complications, especially ischemic stroke, but treatment persistence with warfarin is poor. This study examines Australian nationwide persistence in AF patients using a non-vitamin-K oral anticoagulant (NOAC) drug.
  
  
  
  We assessed national Pharmaceutical Benefit Scheme records November-December 2013 through March 2015 for prescription of NOAC drugs in a 10% random sample of long-term concession card holders. An historical comparison was made with patients prescribed warfarin in 2008. Key outcome measures were (i) the proportion not filling first repeat prescription and (ii) discontinuation within 12 months.
  
  
  
  A total of 1471 patients with AF were new users of a NOAC drug (228 apixaban, 645 dabigatran, 598 rivaroxaban) and 1348 were new users of warfarin. Mean age on a NOAC was 76 years (58% male), on warfarin 74 years (54% male). Only 9% (95% CI 7-10) failed to collect the first repeat prescription on a NOAC, 30% (27-32) discontinued within 12 months; corresponding proportions on warfarin were 14% (12-16) and 62% (60-65). In a regression model adjusted for age, gender, heart failure, hypertension and diabetes, warfarin-treated patients were 2.5 times more likely to discontinue over 12 months than those who were NOAC treated (hazard ratio =2.47 [95% CI 2.19-2.79]).
  
  
  
  Persistence with NOAC drugs in patients with AF appears to be superior to warfarin. If continued long-term, this alone will be of clinical importance in the prevention of stroke and death.
authors.affiliation: a UNSW Lipid Research Department , St Vincent's Hospital , Darlinghurst , NSW , Australia.
authors.forename: Leon A
authors.initials: LA
authors.lastname: Simons
authors.affiliation: b UNSW St Vincent's Clinical School , Darlinghurst , NSW , Australia.|c Zitro Consulting Services , Sydney , Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Ortiz
authors.affiliation: d Sydney Medical School, University of Sydney , Concord Repatriation General Hospital Cardiology Department , NSW , Australia.|e Anzac Institute , Concord , NSW , Australia.
authors.forename: S Ben
authors.initials: SB
authors.lastname: Freedman
authors.affiliation: f Model Solutions Pty Ltd , Sydney , NSW , Australia.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Waterhouse
authors.affiliation: g University of Queensland, Wesley Medical Centre , Auchenflower , QLD , Australia.
authors.forename: David
authors.initials: D
authors.lastname: Colquhoun
authors.affiliation: h Pfizer Australia Pty Ltd , West Ryde , NSW , Australia.
authors.forename: Gareth
authors.initials: G
authors.lastname: Thomas
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D000069604:Dabigatran / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011720:Pyrazoles / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D000069552:Rivaroxaban / Q000627:therapeutic use; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Adherence; Anticoagulants; Medication persistence; NOAC drugs; Non-valvular atrial fibrillation; Thromboembolic stroke; Warfarin