Adherence to dabigatran etexilate in atrial fibrillation patients intended to undergo electrical cardioversion

Willemijn J. Comuth (Corresponding author), Moniek P.M. de Maat, Daan van de Kerkhof, Jerzy Malczynski, Steen Husted, Steen D. Kristensen, Anna Marie B. Münster

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Aims Effective anticoagulation in patients undergoing electrical cardioversion (ECV) for symptomatic atrial fibrillation is important to prevent adverse events. High medication adherence is a requirement. In patients with newly diagnosed atrial fibrillation (n = 169) who were intended to undergo ECV, the aim of this study was to measure self-reported short- and long-term adherence, evaluate whether dabigatran plasma concentrations reflect adherence, measure treatment satisfaction and assess whether adherence and treatment satisfaction are correlated. Methods and results Plasma concentrations (liquid-chromatography tandem mass spectrometry), the 8-point Morisky Medication Adherence Scale (MMAS-8) and the Anti-Clot Treatment Scale (ACTS) were measured after 3 weeks and 7 weeks of treatment. Combined mean peak (1-3 h after intake) and trough (10-16 h after intake) plasma concentrations were 175 (SD 109) ng/mL and 75 (SD 45) ng/mL, respectively. There was no relationship between short-term adherence (last 3 days) or long-term adherence (last 3-4 weeks) and plasma concentrations, unless the last intake was more than 48 h ago. After 7 weeks high, moderate, and low adherence, according to the MMAS-8, was seen in 74%, 21%, and 5% of patients, respectively. Treatment satisfaction was high (median ACTS score 68.5, range 46-75 points). Treatment satisfaction and adherence were not correlated. Conclusion The percentage of patients in the high adherence group (74%) was lower than expected, which is a matter of concern. Dabigatran plasma concentrations could not detect short- or long-term non-adherence, unless the drug was last taken more than 48 h ago. Treatment satisfaction did not correlate with adherence.

LanguageEnglish
Pages91-99
Number of pages9
JournalEuropean Heart Journal - Cardiovascular Pharmacotherapy
Volume5
Issue number2
DOIs
StatePublished - 1 Apr 2019

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Electric Countershock
Atrial Fibrillation
Medication Adherence
Therapeutics
Dabigatran
Tandem Mass Spectrometry
Liquid Chromatography

Keywords

  • Antidepressive agents
  • Atrial fibrillation
  • Dabigatran
  • Drug interactions
  • Mass spectrometry
  • Medication adherence
  • Second generation

Cite this

Comuth, Willemijn J. ; de Maat, Moniek P.M. ; van de Kerkhof, Daan ; Malczynski, Jerzy ; Husted, Steen ; Kristensen, Steen D. ; Münster, Anna Marie B./ Adherence to dabigatran etexilate in atrial fibrillation patients intended to undergo electrical cardioversion. In: European Heart Journal - Cardiovascular Pharmacotherapy. 2019 ; Vol. 5, No. 2. pp. 91-99
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title = "Adherence to dabigatran etexilate in atrial fibrillation patients intended to undergo electrical cardioversion",
abstract = "Aims Effective anticoagulation in patients undergoing electrical cardioversion (ECV) for symptomatic atrial fibrillation is important to prevent adverse events. High medication adherence is a requirement. In patients with newly diagnosed atrial fibrillation (n = 169) who were intended to undergo ECV, the aim of this study was to measure self-reported short- and long-term adherence, evaluate whether dabigatran plasma concentrations reflect adherence, measure treatment satisfaction and assess whether adherence and treatment satisfaction are correlated. Methods and results Plasma concentrations (liquid-chromatography tandem mass spectrometry), the 8-point Morisky Medication Adherence Scale (MMAS-8) and the Anti-Clot Treatment Scale (ACTS) were measured after 3 weeks and 7 weeks of treatment. Combined mean peak (1-3 h after intake) and trough (10-16 h after intake) plasma concentrations were 175 (SD 109) ng/mL and 75 (SD 45) ng/mL, respectively. There was no relationship between short-term adherence (last 3 days) or long-term adherence (last 3-4 weeks) and plasma concentrations, unless the last intake was more than 48 h ago. After 7 weeks high, moderate, and low adherence, according to the MMAS-8, was seen in 74{\%}, 21{\%}, and 5{\%} of patients, respectively. Treatment satisfaction was high (median ACTS score 68.5, range 46-75 points). Treatment satisfaction and adherence were not correlated. Conclusion The percentage of patients in the high adherence group (74{\%}) was lower than expected, which is a matter of concern. Dabigatran plasma concentrations could not detect short- or long-term non-adherence, unless the drug was last taken more than 48 h ago. Treatment satisfaction did not correlate with adherence.",
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Adherence to dabigatran etexilate in atrial fibrillation patients intended to undergo electrical cardioversion. / Comuth, Willemijn J. (Corresponding author); de Maat, Moniek P.M.; van de Kerkhof, Daan; Malczynski, Jerzy; Husted, Steen; Kristensen, Steen D.; Münster, Anna Marie B.

In: European Heart Journal - Cardiovascular Pharmacotherapy, Vol. 5, No. 2, 01.04.2019, p. 91-99.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - Adherence to dabigatran etexilate in atrial fibrillation patients intended to undergo electrical cardioversion

AU - Comuth,Willemijn J.

AU - de Maat,Moniek P.M.

AU - van de Kerkhof,Daan

AU - Malczynski,Jerzy

AU - Husted,Steen

AU - Kristensen,Steen D.

AU - Münster,Anna Marie B.

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N2 - Aims Effective anticoagulation in patients undergoing electrical cardioversion (ECV) for symptomatic atrial fibrillation is important to prevent adverse events. High medication adherence is a requirement. In patients with newly diagnosed atrial fibrillation (n = 169) who were intended to undergo ECV, the aim of this study was to measure self-reported short- and long-term adherence, evaluate whether dabigatran plasma concentrations reflect adherence, measure treatment satisfaction and assess whether adherence and treatment satisfaction are correlated. Methods and results Plasma concentrations (liquid-chromatography tandem mass spectrometry), the 8-point Morisky Medication Adherence Scale (MMAS-8) and the Anti-Clot Treatment Scale (ACTS) were measured after 3 weeks and 7 weeks of treatment. Combined mean peak (1-3 h after intake) and trough (10-16 h after intake) plasma concentrations were 175 (SD 109) ng/mL and 75 (SD 45) ng/mL, respectively. There was no relationship between short-term adherence (last 3 days) or long-term adherence (last 3-4 weeks) and plasma concentrations, unless the last intake was more than 48 h ago. After 7 weeks high, moderate, and low adherence, according to the MMAS-8, was seen in 74%, 21%, and 5% of patients, respectively. Treatment satisfaction was high (median ACTS score 68.5, range 46-75 points). Treatment satisfaction and adherence were not correlated. Conclusion The percentage of patients in the high adherence group (74%) was lower than expected, which is a matter of concern. Dabigatran plasma concentrations could not detect short- or long-term non-adherence, unless the drug was last taken more than 48 h ago. Treatment satisfaction did not correlate with adherence.

AB - Aims Effective anticoagulation in patients undergoing electrical cardioversion (ECV) for symptomatic atrial fibrillation is important to prevent adverse events. High medication adherence is a requirement. In patients with newly diagnosed atrial fibrillation (n = 169) who were intended to undergo ECV, the aim of this study was to measure self-reported short- and long-term adherence, evaluate whether dabigatran plasma concentrations reflect adherence, measure treatment satisfaction and assess whether adherence and treatment satisfaction are correlated. Methods and results Plasma concentrations (liquid-chromatography tandem mass spectrometry), the 8-point Morisky Medication Adherence Scale (MMAS-8) and the Anti-Clot Treatment Scale (ACTS) were measured after 3 weeks and 7 weeks of treatment. Combined mean peak (1-3 h after intake) and trough (10-16 h after intake) plasma concentrations were 175 (SD 109) ng/mL and 75 (SD 45) ng/mL, respectively. There was no relationship between short-term adherence (last 3 days) or long-term adherence (last 3-4 weeks) and plasma concentrations, unless the last intake was more than 48 h ago. After 7 weeks high, moderate, and low adherence, according to the MMAS-8, was seen in 74%, 21%, and 5% of patients, respectively. Treatment satisfaction was high (median ACTS score 68.5, range 46-75 points). Treatment satisfaction and adherence were not correlated. Conclusion The percentage of patients in the high adherence group (74%) was lower than expected, which is a matter of concern. Dabigatran plasma concentrations could not detect short- or long-term non-adherence, unless the drug was last taken more than 48 h ago. Treatment satisfaction did not correlate with adherence.

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KW - Drug interactions

KW - Mass spectrometry

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KW - Second generation

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