ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Pharmacoepidemiology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1562620
This article is part of the Research TopicMathematical Modeling of Medication NonadherenceView all articles
Real-world adherence trajectories to direct oral anticoagulants in naive patients with atrial fibrillation in Spain
Provisionally accepted
Lina Maria Leguízamo-Martínez1
Elena Ballarín2
Isabel Hurtado3
Gabriel Sanfélix-Gimeno3
Francisco Sánchez-Sáez3,4,5*
Mònica Sabaté2- 1Department of Clinical Pharmacology, Area Medicament, Hospital Clinic of Barcelona, Barcelona, Catalonia, Spain
- 2Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
- 3Public Health Research Center, Biomedical Research of Health and the Valencian Community (FISABIO), Valencia, Spain
- 4Department of Applied Statistics and Operational Research, and Quality, Universitat Politècnica de València, Valencia, Valencia, Spain
- 5Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Balearic Islands, Spain
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Aims: This study aimed to identify adherence trajectories and associated factors in atrial fibrillation patients who initiated direct oral anticoagulant (DOAC) therapy, using population-based data from the Catalonia and Valencia regions in Spain during a 2-year follow-up. Methods and Results: Group-based trajectory modelling (GBTM) was applied to assess adherence patterns in cohorts comprising 14,641 patients in Catalonia and 13,211 in Valencia. Adherence trajectories were categorised based on prescription data, revealing three main trajectories in Valencia and five in Catalonia. Most patients in Valencia demonstrated high adherence, whereas Catalonia showed more varied patterns, including early, gradual, and late declines. Factors associated with non-adherence included high co-insurance levels, alcohol use, and specific DOACs, such as dabigatran. Conclusion: Adherence trajectories differed between the two regions, with three identified in Valencia and five in Catalonia. Shared non-adherence patterns were observed across both cohorts, while Catalonia exhibited additional noncompliance trends. Key factors associated with non-adherence included socio-economic variables, clinical characteristics, and the type of DOAC prescribed. Understanding these patterns is essential for developing targeted intervention strategies to improve adherence and optimise treatment outcomes.
Keywords: Direct oral anticoagulants (DOACs), adherence trajectories, atrial fibrillation (AF), group-based trajectory modeling (GBTM), Real-world data analysis
Received: 17 Jan 2025; Accepted: 21 Jul 2025.
Copyright: © 2025 Leguízamo-Martínez, Ballarín, Hurtado, Sanfélix-Gimeno, Sánchez-Sáez and Sabaté. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Francisco Sánchez-Sáez, Public Health Research Center, Biomedical Research of Health and the Valencian Community (FISABIO), Valencia, Spain
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