PRIMARY NON-ADHERENCE AND ASSOCIATED FACTORS IN PATIENTS WITH ATRIAL FIBRILLATION IN GERMANY: A RETROSPECTIVE COHORT STUDY
Author(s)
Karel Kostev, PhD1, Beate Leppert, PhD2, Henning Sievert, PhD3, Maximilan Peters, PhD4, Mark Luedde, MD, PhD5.
1Epidemiology, IQVIA, Frankfurt am Main, Germany, 2Real-World Data Analytics, IQVIA, Frankfurt am Main, Germany, 3Real-World Evidence, IQVIA, Hamburg, Germany, 4Real-World Data Analytics, IQVIA, Munich, Germany, 5Department of Cardiology and Angiology, University of Giessen, Giessen, Germany.
1Epidemiology, IQVIA, Frankfurt am Main, Germany, 2Real-World Data Analytics, IQVIA, Frankfurt am Main, Germany, 3Real-World Evidence, IQVIA, Hamburg, Germany, 4Real-World Data Analytics, IQVIA, Munich, Germany, 5Department of Cardiology and Angiology, University of Giessen, Giessen, Germany.
OBJECTIVES: Atrial fibrillation (AF) is the most common cardiac arrhythmia and requires long-term anticoagulation to prevent thromboembolic events. Primary non-adherence (PNA) - failure to dispense an initially prescribed medication - represents an early and underrecognized barrier to effective treatment. This study aimed to estimate the rate of PNA to oral anticoagulants in AF patients in Germany and to identify associated patient-level factors.
METHODS: In this retrospective cohort study, AF patients receiving an initial prescription of Vitamin K antagonists (VKAs), direct thrombin inhibitors, or direct factor Xa inhibitors between 2016 and 2025 were identified in the IQVIA Disease Analyzer database (1,266 primary care practices). Their prescription histories were combined with records from the IQVIA Longitudinal Prescription (LRx) database using a validated co-therapy-based approach. PNA was defined as failure to dispense the prescription within 30 days. Multivariable logistic regression assessed associations with age, sex, therapy class, comorbidities, and co-therapies.
RESULTS: The study included 87,802 AF patients (mean age: 76.0; SD: 10.7 years; 50.7% female). 86.6% received direct factor Xa inhibitors, 10.2% VKAs, and 3.1% direct thrombin inhibitors. The overall PNA rate was 8.3%. Younger age was associated with higher PNA odds (age ≤50: OR 1.44 [95% CI 1.24-1.67]; age 51-60: OR 1.21 [1.10-1.32] vs. age >80). Direct factor Xa inhibitors (OR 0.69 [0.64-0.74]) and direct thrombin inhibitors (OR 0.74 [0.64-0.86]) were associated with lower PNA than VKAs. Co-diagnoses of heart failure (OR 0.88; [0.83-0.94]) and history of myocardial infarction (OR 0.80 [0.68-0.94]) were also associated with lower PNA.
CONCLUSIONS: Approximately one in twelve AF patients in Germany did not dispense their initial anticoagulant prescription. Younger age and VKA therapy were independently associated with higher odds of PNA, suggesting that these subgroups may benefit from targeted educational and adherence support at the point of prescription.
METHODS: In this retrospective cohort study, AF patients receiving an initial prescription of Vitamin K antagonists (VKAs), direct thrombin inhibitors, or direct factor Xa inhibitors between 2016 and 2025 were identified in the IQVIA Disease Analyzer database (1,266 primary care practices). Their prescription histories were combined with records from the IQVIA Longitudinal Prescription (LRx) database using a validated co-therapy-based approach. PNA was defined as failure to dispense the prescription within 30 days. Multivariable logistic regression assessed associations with age, sex, therapy class, comorbidities, and co-therapies.
RESULTS: The study included 87,802 AF patients (mean age: 76.0; SD: 10.7 years; 50.7% female). 86.6% received direct factor Xa inhibitors, 10.2% VKAs, and 3.1% direct thrombin inhibitors. The overall PNA rate was 8.3%. Younger age was associated with higher PNA odds (age ≤50: OR 1.44 [95% CI 1.24-1.67]; age 51-60: OR 1.21 [1.10-1.32] vs. age >80). Direct factor Xa inhibitors (OR 0.69 [0.64-0.74]) and direct thrombin inhibitors (OR 0.74 [0.64-0.86]) were associated with lower PNA than VKAs. Co-diagnoses of heart failure (OR 0.88; [0.83-0.94]) and history of myocardial infarction (OR 0.80 [0.68-0.94]) were also associated with lower PNA.
CONCLUSIONS: Approximately one in twelve AF patients in Germany did not dispense their initial anticoagulant prescription. Younger age and VKA therapy were independently associated with higher odds of PNA, suggesting that these subgroups may benefit from targeted educational and adherence support at the point of prescription.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH110
Topic
Clinical Outcomes, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Safety & Pharmacoepidemiology
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)