Adherence and treatment satisfaction among atrial fibrillation patients treated with VKAs versus NOACs: real-world data from a single-center cohort
K Lomper, K KempfertAbstract
Oral anticoagulation is the cornerstone of stroke prevention in atrial fibrillation (AF). Non-vitamin K antagonist oral anticoagulants (NOACs) are expected to improve adherence and satisfaction compared with vitamin K antagonists (VKAs) due to simplified dosing and lack of routine INR monitoring. However, real-world evidence remains inconsistent.
Purpose: To compare adherence and treatment satisfaction among AF patients treated with VKAs and NOACs in a real-world clinical setting.
Methods: A cross-sectional study was conducted among 100 patients with diagnosed AF (mean age 73.1 ± 6.5 years; 52% women) receiving oral anticoagulation for an average of 3.3 ± 2.1 years.
Patients were categorized into VKA users (n = 47; 25% warfarin, 22% acenocoumarol) and NOAC users (n = 53; 38% rivaroxaban, 11% apixaban, 4% edoxaban).
Adherence was assessed using a validated adherence scale, and treatment satisfaction using the Perception of Anticoagulant Treatment Questionnaire (PACTQ-2).
Results: Mean adherence scores did not differ significantly between VKA and NOAC users (21.79 ± 4.55 vs. 23.38 ± 3.71; p = 0.057).Similarly, satisfaction scores were comparable across groups (51.75 ± 14.74 vs. 55.53 ± 13.84; p = 0.190). No associations were observed between adherence and clinical variables such as AF type, comorbidities, or polypharmacy. In both treatment groups, higher satisfaction correlated moderately with better adherence (r = 0.35, p < 0.001).
Conclusions: In this real-world AF cohort, adherence and treatment satisfaction did not significantly differ between patients treated with VKAs and those receiving NOACs. Despite pharmacological advantages of NOACs, behavioral and perceptual factors appear equally relevant in determining treatment adherence. Patient-centered strategies addressing satisfaction and perception of therapy may enhance long-term anticoagulation control.