Atrial fibrillation (AF) is an independent risk factor of stroke, the most common disability in the United States. When used adequately, Direct oral anticoagulants (DOACs) substantially reduce the stroke events in patients with AF. Despite documented beneficial effects of anticoagulation therapy, poor persistence to DOACs is widely reported potentially due to the lack of frequent laboratory monitoring. Comorbidities frequently associated with AF include hypertension, diabetes, and hyperlipidemia, which further increase morbidity and mortality. The objective of this study was to evaluate the persistence of DOACs and to identify the predictors associated with non-persistence among patients with AF and comorbid hypertension, diabetes, and hyperlipidemia.

This retrospective study identified patients with AF, hypertension, diabetes, and hyperlipidemia enrolled in Medicare Advantage Plan (MAPD) from January 2016-December 2019. Patients with one refill for either Dabigatran, Rivaroxaban or Apixaban from January 2019-December 2019 were enrolled and followed for 180 days. The outcome variable was non-persistence, defined as a refill gap of more than 60 days of the previous prescription. Multivariable logistic regression model was conducted to identify the predictors of non-persistence to DOACs. Predictors included in the model were the baseline characteristics, including age, gender, low-income subsidy, use of antiplatelet agents, antiarrhythmic agents, proton pump inhibitors, nonsteroidal anti-inflammatory agents, and comorbidities like cardiovascular diseases, stroke, and risk score.

Final cohort comprised of 189 patients on DOACs with comorbid hypertension, diabetes, and hyperlipidemia. Of these 136 (71.96%) were persistent to DOACs at 180 days. Patients who had stroke events at baseline were significantly less likely to be non-persistent to DOACs (OR=0.34;95% CI 0.12-0.93; P=0.03).

Overall, the persistence sub-optimal. Long-term persistence plays a substantial role in maximizing treatment benefits and preventing adverse events. Future research assessing the impact of the persistence of clinical outcomes among patients with AF and other comorbidities are warranted.