Factors influencing adherence to oral anticoagulation in elderly atrial fibrillation patients

Abstract Background Atrial fibrillation (AF) is highly prevalent among older adults, a population inherently at elevated risk for AF-related complications. This increased risk underscores the importance of adherence to oral anticoagulant (OAC) therapy in mitigating thromboembolic events. Addressing age-related factors such as concerns over side effects and the complexity of therapy can thus improve adherence rates, ultimately enhancing clinical outcomes in elderly AF patients. Purpose Evaluation of adherence levels and identification of adherence determinants in elderly patients with AF undergoing OAC therapy. Methods This study included 100 patients diagnosed with AF (mean age 73.11 years) undergoing OAC therapy for a minimum duration of 6 months. The assessment tools included analysis of medical records, the HAS-BLED scale, the CHA2DS2-VASc scale, and the Adherence in Chronic Diseases Scale (ACDS) to evaluate adherence. Results The majority of participants were female (52%) and in a relationship (54%), with paroxysmal AF as the most common diagnosis (79%). Most patients presented with a HAS-BLED score ≥3 (99%) and a CHA2DS2-VASc score ≥3 (98%), and 44% were classified as EHRA class 2a. Polypharmacy was noted in 57% of participants, with 68% exhibiting multimorbidity. OAC therapy with NOACs was administered to 53% of patients, specifically rivaroxaban (38%), apixaban (11%), and edoxaban (4%). VKA therapy was utilized by 47% of patients, with warfarin (25%) and acenocoumarol (22%) being the primary agents. The mean duration of OAC therapy was 3.28 years (Me 3.00; SD = 2.12), while the mean adherence score (ACSD) was 22.63 points (Me 23.00; SD = 4.18). Analysis demonstrated a significant association between adherence and educational attainment (p < 0.001). Participants perceiving treatment costs as burdensome exhibited lower adherence scores (mean 19.56) than those without such concerns (mean 24.07, p < 0.001, η² = 0.27). Patients reporting fear of adverse effects showed significantly lower adherence (mean 19.62) compared to those without such concerns (mean 23.69, p < 0.001, η² = 0.19). While there was no statistically significant difference in adherence between NOAC and VKA (p = 0.057), NOAC users demonstrated slightly higher adherence (mean 23.38) relative to VKA users (mean 21.79). Conclusions The findings indicate that adherence to OAC therapy in elderly AF patients is multifactorial, shaped by socioeconomic, psychological, and treatment-perception factors. Improving adherence in this demographic requires targeted interventions focusing on patient education, financial assistance, and the reduction of anxiety surrounding potential side effects. The trend towards higher adherence in NOAC users may be attributable to the reduced complexity of NOAC therapy, which could be particularly beneficial in populations with cognitive or functional impairments.