title: Drug Adherence in Patients With Nonvalvular Atrial Fibrillation Taking Non-Vitamin K Antagonist Oral Anticoagulants in Turkey: NOAC-TR.
abstract: Adherence to non-vitamin K antagonist oral anticoagulants (NOACs) is an important factor for ensuring efficacy and safety in nonvalvular atrial fibrillation (NVAF). There are controversial results regarding NOAC adherence in real-world data and there are no data about NOAC adherence in Turkish population. This study investigated the NOAC adherence based on self-report, factors affecting nonadherence, and the relation of the adherence level with efficacy and safety outcomes. This multicenter cross-sectional study included 2738 patients (59% female) using NOAC (dabigatran, apixaban, and rivaroxaban) due to NVAF for more than 3 months with >30 days of supply between September 1, 2015, and February 28, 2016. To measure the adherence level, an 8-item Morisky Medication Adherence Scale was used. The mean age of the patients was 70 ± 10 years. Of the 2738 patients, 44% were receiving dabigatran, 38% rivaroxaban, and 18% apixaban. A total of 630 (23%) patients had high medication adherence, 712 (26%) moderate adherence, and 1396 (51%) low adherence. Nonadherence had related to stroke (5.6% vs 2.5%, P < .001) and minor (21.2% vs 11.1%, P < .001) and major (6.1% vs 3.7%, P = .004) bleeding rates. The adherence to NOAC was found to be quite low in Turkey. Nonadherence is associated with bleeding and thromboembolic cardiovascular events. Age, taking NOAC twice a day, and the additional noncardiac diseases, depression, and dementia were the independent factors affecting poor medication adherence.
authors.affiliation: 1 Department of Cardiology, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey.
authors.forename: Sadık Volkan
authors.initials: SV
authors.lastname: Emren
authors.affiliation: 2 Department of Cardiology, Artvin State Hospital, Artvin, Turkey.
authors.forename: Oktay
authors.initials: O
authors.lastname: Şenöz
authors.affiliation: 3 Department of Cardiology, Ankara Dışkapı Research and Education Hospital, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Bilgin
authors.affiliation: 4 Department of Cardiology, Sivas Cumhuriyet University, Sivas, Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Beton
authors.affiliation: 5 Department of Cardiology, Dokuz Eylül University, Izmir, Turkey.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Aslan
authors.affiliation: 6 Department of Cardiology, Akşehir State Hospital, Konya, Turkey.
authors.forename: Uğur
authors.initials: U
authors.lastname: Taşkin
authors.affiliation: 7 Department of Cardiology, Istanbul İstinye State Hospital, Istanbul, Turkey.
authors.forename: Gönül
authors.initials: G
authors.lastname: Açiksari
authors.affiliation: 3 Department of Cardiology, Ankara Dışkapı Research and Education Hospital, Ankara, Turkey.
authors.forename: Lale Dinç
authors.initials: LD
authors.lastname: Asarcikli
authors.affiliation: 8 Department of Cardiology, Darıca Farabi State Hospital, Kocaeli, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Çakir
authors.affiliation: 9 Department of Cardiology, Hitit University, Çorum, Turkey.
authors.forename: Lütfü
authors.initials: L
authors.lastname: Bekar
authors.affiliation: 10 Department of Cardiology, Fethiye State Hospital, Muğla, Turkey.
authors.forename: İsmail
authors.initials: İ
authors.lastname: Bolat
authors.affiliation: 11 Department of Cardiology, Ankara Yüksek İhtisas Research and Education Hospital, Ankara, Turkey.
authors.forename: Çağrı
authors.initials: Ç
authors.lastname: Yayla
authors.affiliation: 12 Department of Cardiology, Silifke State Hospital, Mersin, Turkey.
authors.forename: Barış
authors.initials: B
authors.lastname: Çelebi
authors.affiliation: 13 Department of Cardiology, Karşıyaka State Hospital, İzmir, Turkey.
authors.forename: Onur
authors.initials: O
authors.lastname: Dalgiç
authors.affiliation: 14 Department of Cardiology, School of Medicine, Hitit University, Çorum, Turkey.
authors.forename: Oğuzhan
authors.initials: O
authors.lastname: Çelik
authors.affiliation: 15 Department of Cardiology, Burdur State Hospital, Burdur, Turkey.
authors.forename: Özgen
authors.initials: Ö
authors.lastname: Şafak
authors.affiliation: 16 Department of Cardiology, Münif İslamoğlu State Hospital, Kastamonu, Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Akyel
authors.affiliation: 17 Department of Cardiology, Aydın University School of Medicine, Aydın, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Güngör
authors.affiliation: 18 Department of Cardiology, Mersin State Hospital, Mersin, Turkey.
authors.forename: Barış
authors.initials: B
authors.lastname: Düzel
authors.affiliation: 19 Department of Cardiology, Ege University, Izmir, Turkey.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Zoghi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006470:Hemorrhage; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D057566:Self Report; D020521:Stroke; D014421:Turkey
chemical_list: D000925:Anticoagulants
keywords: bleeding; medication adherence; non-vitamin K antagonists; self-report