OBJECTIVES

Despite superior clinical outcomes demonstrated for NOACs over warfarin in patients with non-valvular atrial fibrillation (NVAF), issues related to lack of adherence and persistence with NOAC treatments in some patients remain which might in turn be associated with adverse clinical outcomes including stroke and increased health costs.

Low adherence to NOAC therapy in subjects with NVAF was previously demonstrated in Turkey. There are no published studies regarding barriers affecting adherence and persistence to NOAC treatment and strategies to overcome them.

We aimed to generate a consensus report that addresses barriers influencing treatment adherence and persistence to NOAC treatments for the prevention of NVAF related embolic complications in Turkey and to recommend solutions.

METHODS

An expert panel of 6 cardiologists and 2 neurologists who are experienced in NVAF and stroke prevention was convened using a 2 round modified Delphi method (survey and in person meeting) to determine barriers affecting adherence and persistence to NOAC treatments in NVAF patients. Additionally, a facilitated discussion was performed to establish recommendations to overcome these barriers; we report those with 100% consensus.

RESULTS

Inadequate information on NVAF was considered as the most important patient-driven barrier influencing treatment adherence and persistence, while inability to spend sufficient time with patients for most of the cases was suggested as the most important physician-driven one.

Regarding treatment access; the prerequisite in Turkey for warfarin usage prior to NOACs needs to be revisited in parallel with international treatment guidelines, 6-month medical report duration can be extended to at least 12 months and frequency of follow-up visits should be individualized based on patient characteristics to improve adherence and persistence to NOAC treatments.

CONCLUSIONS

It is demonstrated that increasing treatment adherence and persistence to NOAC treatments is a continuum requiring multi-stakeholder collaboration aiming to alleviate barriers from patients, physicians and access conditions perspectives.