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Telemonitoring Improves NOAC Adherence in AF Patients
Study Questions:
Does a telemonitoring intervention improve adherence to anticoagulation medication in patients with atrial fibrillation (AF)?
Methods:
A randomized, single-blind, crossover, controlled study design was used to evaluate the effects of telemonitoring on adherence to non–vitamin K antagonist oral anticoagulants (NOACs) among AF patients. The Medication Event Monitoring System tracked NOAC intake during three phases of 3 months each: daily telemonitoring, telemonitoring with immediate telephone feedback in case of intake errors, and an observation phase without daily transmissions. Unprotected days were defined as ≥3 or ≥1 consecutively missed doses for a twice per day or once per day NOAC, respectively, or excess dose intake. Cost-effectiveness was calculated based on anticipated stroke reduction derived from patients’ risk profile and measured intake.
Results:
A total of 48 patients with AF were included in this trial. Telemonitoring-only was associated with very high taking and regimen adherence (97.4% and 93.8%, respectively). Direct feedback further improved both taking and regimen adherence to 99.0% and 96.8%, respectively (p < 0.001 and p = 0.002, respectively). Observation without daily monitoring resulted in a significant waning of taking adherence (94.3%; p = 0.049). Taking adherence was significantly higher for once per day compared to twice per day NOACs, although unprotected days were similar. Feedback intervention had an incremental cost of €344,289 to prevent one stroke, but this could be as low as €15,488 in high-risk patients with low adherence and optimized technology.
Conclusions:
The authors concluded that telemonitoring resulted in high NOAC adherence due to the notion of being watched, as evidenced by the rapid decline during the observation period. Feedback further optimized adherence. Telemonitoring with or without feedback may be a cost-effective approach in high-risk patients deemed poorly adherent.
Perspective:
This was a small study, which needs to be replicated in larger cohorts. However, these results suggest that such monitoring may be helpful among patients at high risk for nonadherence to NOAC therapy.
Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Cost-Benefit Analysis, Drug Monitoring, Medication Adherence, Observation, Patient Compliance, Stroke, Telephone
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