Adherence to dabigatran therapy and longitudinal patient outcomes: Insights from the Veterans Health Administration

Supriya Shore, Evan P. Carey, Mintu P. Turakhia, Cynthia A. Jackevicius, Fran Cunningham, Louise Pilote, Steven M. Bradley, Thomas M. Maddox, Gary K. Grunwald, Anna E. Barón, John S. Rumsfeld, Paul D. Varosy, Preston M. Schneider, Lucas N. Marzec, P. Michael Ho

Research output: Contribution to journalArticlepeer-review

191 Scopus citations


Background Dabigatran is a novel oral anti-coagulant (NOAC) that reduces risk of stroke in patients with non-valvular atrial fibrillation (NVAF). It does not require routine monitoring with laboratory testing which may have an adverse impact on adherence. We aimed to describe adherence to dabigatran in the first year after initiation and assess the association between non-adherence to dabigatran and clinical outcomes in a large integrated healthcare system. Methods We studied a national cohort of 5,376 patients with NVAF, initiated on dabigatran between October-2010 and September-2012 at all Veterans Affairs hospitals. Adherence to dabigatran was calculated as proportion of days covered (PDC) and association between PDC and outcomes was assessed using standard regression techniques. Results Mean age of the study cohort was 71.3 ± 9.7 years; 98.3% were men and mean CHADS2 score was 2.4 ± 1.2 (mean CHA2DS2VASc score 3.2 ± 1.4). Median PDC was 94% (IQR 76%-100%; mean PDC 84% ± 22%) over a median follow-up of 244 days (IQR 140-351). A total of 1,494 (27.8%) patients had a PDC <80% and were classified as non-adherent. After multivariable adjustment, lower adherence was associated with increased risk for combined all-cause mortality and stroke (HR 1.13, 95% CI 1.07-1.19 per 10% decrease in PDC). Adherence to dabigatran was not associated with non-fatal bleeding or myocardial infarction. Conclusions In the year after initiation, adherence to dabigatran for a majority of patients is very good. However, 28% of patients in our cohort had poor adherence. Furthermore, lower adherence to dabigatran was associated with increased adverse outcomes. Concerted efforts are needed to optimize adherence to NOACs.

Original languageEnglish
Pages (from-to)810-817
Number of pages8
JournalAmerican heart journal
Issue number6
StatePublished - Jun 2014


Dive into the research topics of 'Adherence to dabigatran therapy and longitudinal patient outcomes: Insights from the Veterans Health Administration'. Together they form a unique fingerprint.

Cite this