A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF)
Background/Aims Efforts to reduce stroke in patients with atrial fibrillation (AF) have focused on increasing physician adherence to oral anticoagulant (OAC) guidelines; however, the high early discontinuation rate of vitamin K antagonists (VKAs) is a limitation. Although non-VKA OACs (NOACs) are mo...
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
The Korean Association of Internal Medicine
2020-01-01
|
| Series: | The Korean Journal of Internal Medicine |
| Subjects: | |
| Online Access: | http://www.kjim.org/upload/pdf/kjim-2017-415.pdf |
| _version_ | 1829484074147774464 |
|---|---|
| author | Hyeongsoo Kim Young Soo Lee Tae-Hoon Kim Myung-Jin Cha Jung Myung Lee Junbeom Park Jin-Kyu Park Ki-Woon Kang Jaemin Shim Jae-Sun Uhm Hyung Wook Park Eue-Keun Choi Jin-Bae Kim Changsoo Kim Jun Kim Boyoung Joung |
| author_facet | Hyeongsoo Kim Young Soo Lee Tae-Hoon Kim Myung-Jin Cha Jung Myung Lee Junbeom Park Jin-Kyu Park Ki-Woon Kang Jaemin Shim Jae-Sun Uhm Hyung Wook Park Eue-Keun Choi Jin-Bae Kim Changsoo Kim Jun Kim Boyoung Joung |
| author_sort | Hyeongsoo Kim |
| collection | DOAJ |
| description | Background/Aims Efforts to reduce stroke in patients with atrial fibrillation (AF) have focused on increasing physician adherence to oral anticoagulant (OAC) guidelines; however, the high early discontinuation rate of vitamin K antagonists (VKAs) is a limitation. Although non-VKA OACs (NOACs) are more convenient to administer than warfarin, their lack of monitoring may predispose patients to nonpersistence. We compared the persistence of NOAC and VKA treatment for AF in real-world practice. Methods In a prospective observational registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF] registry), 7,013 patients with nonvalvular AF (mean age 67.2 ± 10.9 years, women 36.4%) were consecutively enrolled between June 2016 and June 2017 from 10 tertiary hospitals in Korea. This study included 3,381 patients who started OAC 30 days before enrollment (maintenance group) and 572 patients who newly started OAC (new-starter group). The persistence rate of OAC was evaluated. Results In the maintenance group, persistence to OAC declined during 6 months, to 88.3% for VKA and 95.5% for NOAC (p < 0.0001). However, the persistence rate was not different among NOACs. In the new-starter group, persistence to OAC declined during 6 months, to 78.9% for VKA and 92.1% for NOAC (p < 0.0001). The persistence rate was lower for rivaroxaban (83.7%) than apixaban (94.6%) and edoxaban (94.1%, p < 0.001). In the new-starter group, diabetes, valve disease, and cancer were related to nonpersistence of OAC. Conclusions Nonpersistence was significantly lower with NOAC than VKA in both the maintenance and new-starter groups. In only the new-starter group, apixaban or edoxaban showed higher persistence rates than rivaroxaban. |
| first_indexed | 2024-12-14T22:20:17Z |
| format | Article |
| id | doaj.art-ac80f697977649efb0c70445b7977ed0 |
| institution | Directory Open Access Journal |
| issn | 1226-3303 2005-6648 |
| language | English |
| last_indexed | 2024-12-14T22:20:17Z |
| publishDate | 2020-01-01 |
| publisher | The Korean Association of Internal Medicine |
| record_format | Article |
| series | The Korean Journal of Internal Medicine |
| spelling | doaj.art-ac80f697977649efb0c70445b7977ed02022-12-21T22:45:32ZengThe Korean Association of Internal MedicineThe Korean Journal of Internal Medicine1226-33032005-66482020-01-013519910810.3904/kjim.2017.415170193A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF)Hyeongsoo Kim0Young Soo Lee1Tae-Hoon Kim2Myung-Jin Cha3Jung Myung Lee4Junbeom Park5Jin-Kyu Park6Ki-Woon Kang7Jaemin Shim8Jae-Sun Uhm9Hyung Wook Park10Eue-Keun Choi11Jin-Bae Kim12Changsoo Kim13Jun Kim14Boyoung Joung15 Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea Department of Cardiology, Ewha Womans University School of Medicine, Seoul, Korea Department of Cardiology, Hanyang University Seoul Hospital, Seoul, Korea Division of Cardiology, Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Korea Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Korea Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, KoreaBackground/Aims Efforts to reduce stroke in patients with atrial fibrillation (AF) have focused on increasing physician adherence to oral anticoagulant (OAC) guidelines; however, the high early discontinuation rate of vitamin K antagonists (VKAs) is a limitation. Although non-VKA OACs (NOACs) are more convenient to administer than warfarin, their lack of monitoring may predispose patients to nonpersistence. We compared the persistence of NOAC and VKA treatment for AF in real-world practice. Methods In a prospective observational registry (COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF] registry), 7,013 patients with nonvalvular AF (mean age 67.2 ± 10.9 years, women 36.4%) were consecutively enrolled between June 2016 and June 2017 from 10 tertiary hospitals in Korea. This study included 3,381 patients who started OAC 30 days before enrollment (maintenance group) and 572 patients who newly started OAC (new-starter group). The persistence rate of OAC was evaluated. Results In the maintenance group, persistence to OAC declined during 6 months, to 88.3% for VKA and 95.5% for NOAC (p < 0.0001). However, the persistence rate was not different among NOACs. In the new-starter group, persistence to OAC declined during 6 months, to 78.9% for VKA and 92.1% for NOAC (p < 0.0001). The persistence rate was lower for rivaroxaban (83.7%) than apixaban (94.6%) and edoxaban (94.1%, p < 0.001). In the new-starter group, diabetes, valve disease, and cancer were related to nonpersistence of OAC. Conclusions Nonpersistence was significantly lower with NOAC than VKA in both the maintenance and new-starter groups. In only the new-starter group, apixaban or edoxaban showed higher persistence rates than rivaroxaban.http://www.kjim.org/upload/pdf/kjim-2017-415.pdfatrial fibrillationanticoagulantsdabigatranrivaroxabanapixaban |
| spellingShingle | Hyeongsoo Kim Young Soo Lee Tae-Hoon Kim Myung-Jin Cha Jung Myung Lee Junbeom Park Jin-Kyu Park Ki-Woon Kang Jaemin Shim Jae-Sun Uhm Hyung Wook Park Eue-Keun Choi Jin-Bae Kim Changsoo Kim Jun Kim Boyoung Joung A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) The Korean Journal of Internal Medicine atrial fibrillation anticoagulants dabigatran rivaroxaban apixaban |
| title | A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) |
| title_full | A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) |
| title_fullStr | A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) |
| title_full_unstemmed | A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) |
| title_short | A prospective survey of the persistence of warfarin or NOAC in nonvalvular atrial fibrillation: a COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) |
| title_sort | prospective survey of the persistence of warfarin or noac in nonvalvular atrial fibrillation a comparison study of drugs for symptom control and complication prevention of atrial fibrillation code af |
| topic | atrial fibrillation anticoagulants dabigatran rivaroxaban apixaban |
| url | http://www.kjim.org/upload/pdf/kjim-2017-415.pdf |
| work_keys_str_mv | AT hyeongsookim aprospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT youngsoolee aprospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT taehoonkim aprospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT myungjincha aprospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT jungmyunglee aprospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT junbeompark aprospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT jinkyupark aprospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT kiwoonkang aprospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT jaeminshim aprospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT jaesunuhm aprospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT hyungwookpark aprospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT euekeunchoi aprospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT jinbaekim aprospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT changsookim aprospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT junkim aprospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT boyoungjoung aprospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT hyeongsookim prospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT youngsoolee prospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT taehoonkim prospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT myungjincha prospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT jungmyunglee prospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT junbeompark prospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT jinkyupark prospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT kiwoonkang prospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT jaeminshim prospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT jaesunuhm prospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT hyungwookpark prospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT euekeunchoi prospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT jinbaekim prospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT changsookim prospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT junkim prospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf AT boyoungjoung prospectivesurveyofthepersistenceofwarfarinornoacinnonvalvularatrialfibrillationacomparisonstudyofdrugsforsymptomcontrolandcomplicationpreventionofatrialfibrillationcodeaf |