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European Society of Cardiology

Clinical Articles, Lead Article

Patient education does not improve apixaban adherence

Adherence to the oral anticoagulant apixaban among patients with atrial fibrillation (AF) was not improved by an educational programme, according to results from the AEGEAN (Assessment of an Education and Guidance Programme for Eliquis Adherence in Non-Valvular Atrial Fibrillation) trial presented recently at ESC Congress 2015.

The AEGEAN trial included AF patients treated with apixaban who received either an educational programme (n=579) or usual information about the disease and treatment (n=583) to see if there were differences in two outcomes: treatment adherence (defined as continuous twice daily dosing, with an occasional missed dose allowed) and treatment persistence (defined as absence of discontinuation for 30 consecutive days) over a six month observational period.

The educational programme included a patient information booklet explaining AF and anticoagulant treatment for stroke prevention, reminder tools (e.g., key ring, mobile phone alerts), and access to a virtual clinic utilising staff from existing non-vitamin K antagonists (VKAs) monitoring clinics. Adherence was measured using an electronic device that holds a blister pack of medication and records each time the pack is removed.

Professor Gilles Montalescot (Centre Hospitalier Universitaire Pitié-Salpêtriėre)

Professor Gilles Montalescot (Centre Hospitalier Universitaire Pitié-Salpêtriėre)

The study found there was no additional value of the educational programme on either outcome. At 24 weeks, the adherence rate was 88.5% in the control group and 88.3% in the education group (p=0.89), and persistence rates were 90.5% and 91.1% respectively (p=0.76).

The results were nevertheless “quite encouraging,” according to lead investigator Professor Gilles Montalescot (Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtriėre, Paris, France).

“We used the best possible tools for the educational programme, including the usual staff and procedures of the anticoagulation clinics, and all of this was useless. However, the trial showed very good adherence to apixaban, leaving little room for improvement with an educational programme, suggesting one more advantage of prescribing non-VKAs over VKAs in that there is apparently no need for additional education and information,” Professor Montalescot said.

“Future studies may want to test more aggressive and more costly educational programmes, but in the meantime the adherence and persistence rates we measured are quite reassuring with the common practice and usual mode of prescription of this medication,” concluded Professor Montalescot.

References

1. Montalescot G. Assessment of an education and guidance program for apixaban adherence in non-valvular atrial fibrillation: the randomized AEGEAN study. European Society of Cardiology 2015 Congress. Abstract 2191

Published on: September 30, 2015

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ENDORSED BY

  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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