P832Persistence after initiation of oral anticoagulant for atrial fibrillation in France

Abstract

Background: Evaluation of oral anticoagulant (OAC) use during routine care may help to assess whether patients are maintaining long-term stroke prevention therapy. We used French primary care data to describe characteristics of patients with atrial fibrillation (AF) receiving OACs and compared OAC persistence. Methods: Cohort of patients with AF who were newly prescribed OACs (recommended doses, with no prior OAC therapy) between 1-Jan-14 and 31-Jan-16 using the IMS Longitudinal Patient Database in France. Patient characteristics were described. Time to non-persistence (discontinuation/switch) was compared across OACs using Cox regression, adjusted for demographics, comorbidities and concomitant therapies. Results: Of 4111 patients newly prescribed OACs in the study period (1710 VKA, 1257 rivaroxaban, 744 apixaban, 400 dabigatran), median age at initiation was 76 years (interquartile range [IQR] 67-83) and 57.5% were male. Of stroke risk factors, history of hypertension was the most common (68.1%), followed by vascular disease (26.8%) and thromboembolism (23.9%). History of hypertension and thromboembolism were more common in apixaban treated patients. Mean CHA2DS2-VASc score was 3.3 (standard deviation 1.5), higher in VKA patients, and HAS-BLED score was 2.6 (1.0), higher in apixaban patients. After median follow-up between 8.8 (apixaban, IQR 4.7-13.1) and 14.5 months (dabigatran, IQR 8.1-20.0), and adjusting for characteristics, non-persistence was higher with rivaroxaban (hazard ratio 1.28, 95% confidence interval 1.13-1.45) and dabigatran (1.42, 1.20-1.69) compared to VKA. Apixaban non-persistence was similar (1.12, 0.96-1.32) to that for VKA. Conclusion: In patients newly treated with OACs in French primary care, NOACs were more commonly prescribed than VKA. After adjusting for potential differences in prescribing, apixaban was continued at a similar rate to VKA whilst persistence was lower with dabigatran and rivaroxaban. Clinicians may consider these results given evidence of continued use and improved stroke prevention.