Российский кардиологический журнал (Jun 2023)
Factors determining adherence to anticoagulant therapy in patients with atrial fibrillation
Abstract
Aim. To identify risk factors for low adherence and develop a scale for its prediction. To evaluate the association of the predictive score with actual low adherence according to the 8-item Morisky Medication Adherence Scale, self-drug withdrawal, and adverse outcomes in patients with atrial fibrillation (AF).Material and methods. The study included patients with AF and a high risk of thromboembolic events according to the CHA2DS2-VASc scale, who were hospitalized from January 2011 to December 2017. Potential risk factors for non-adherence, selected from the literature, were tested in a multivariate regression analysis followed by the development of an adherence prediction scale. The association of predicted low adherence with actual adherence was assessed.Results. The study included 199 patients. The analysis identified following predictors of low adherence: low income, history of bleeding, prior stroke, 4 positive responses to the adherence questionnaire, warfarin. Based on these predictors, a scale for predicting adherence was developed, while a threshold value of 3 points was identified (sensitivity, 90,2%, specificity, 98,4%). A significant association of low predicted adherence on the developed scale with actual adherence and adverse outcomes was demonstrated.Conclusion. We have developed a scale for predicting adherence to anticoagulant therapy, and also determined its threshold value. In case of a high risk of low adherence, clinicians should try to increase adherence in order to prevent complications.
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