Educational Impact on Apixaban Adherence in Atrial Fibrillation (the AEGEAN STUDY) : A Randomized Clinical Trial
Montalescot, Gilles (Centre Hospitalier Universitaire Pitié-Salpêtriėre)
Brotons, Carlos (Institut d'Investigació Biomèdica Sant Pau)
Cosyns, Bernard (Universitair Ziekenhuis Brussel)
Crijns, Harry J. (Maastricht University Medical Centre)
D'Angelo, Armando (Scientific Institute San Raffaele)
Drouet, Ludovic (Paris Diderot University)
Eberli, Franz R. (Stadtspital Triemli)
Lane, Deirdre (University of Liverpool and Liverpool Heart & Chest Hospital)
Besse, Bruno (Bristol-Myers Squibb)
Chan, Anthony (Pfizer Healthcare Ireland)
Vicaut, Eric (Centre Hospitalier Universitaire Lariboisière (AP-HP))
Darius, Harald (Vivantes Neukoelln Medical Center)
Universitat Autònoma de Barcelona

Data:	2020
Resum:	Adherence to non-vitamin-K oral anticoagulants (NOACs) may be lower than to vitamin K antagonists because NOACs do not require routine monitoring. We assessed the impact of an educational program on adherence and persistence with apixaban in patients with non-valvular atrial fibrillation (NVAF). Patients with NVAF eligible for NOACs with one or more stroke risk factor (prior stroke/transient ischemic attack, age ≥ 75 years, hypertension, diabetes, or symptomatic heart failure) were randomized (1:1) to standard of care (SOC) or SOC with additional educational (information booklet, reminder tools, virtual clinic access). The primary outcome was adherence to apixaban (2. 5 or 5 mg twice daily) at 24 weeks. Patients receiving the educational program were re-randomized (1:1) to continue the program for 24 further weeks or to switch to secondary SOC. Implementation adherence and persistence were reassessed at 48 weeks. In total, 1162 patients were randomized (SOC, 583; educational program, 579). Mean implementation adherence ± standard deviation (SD) at 24 weeks was 91. 6% ± 17. 1 for SOC and 91. 9% ± 16. 1 for the educational program arm; results did not differ significantly between groups at any time-point. At 48 weeks, implementation adherence was 90. 4% ± 18. 0, 90. 1% ± 18. 6, and 89. 3% ± 18. 1 for continued educational program, SOC, and secondary SOC, respectively; and corresponding persistence was 86. 1% (95% confidence interval [CI] 81. 3-89. 7), 85. 2% (95% CI 81. 5-88. 2), and 87. 8% (95% CI 83. 4-91. 1). Serious adverse events were similar across groups. High implementation adherence and persistence with apixaban were observed in patients with NVAF receiving apixaban. The educational program did not show additional benefits. This study is registered at ClinicalTrials. gov [NCT01884350].
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	American Journal of Cardiovascular Drugs, Vol. 20 Núm. 1 (january 2020) , p. 61-71, ISSN 1179-187X

DOI: 10.1007/s40256-019-00356-2
PMID: 31243691

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