Project 462408

Atrial fibrillation (Afib) is a common type of irregular heartbeat that affects more than half a million Canadians. Patients with Afib are at much higher risk of stroke than those without Afib. Stroke can lead to disability or death, so it is crucial to prevent it in those at risk. A group of medications called oral anticoagulants (OACs) are very effective for preventing stroke in Afib patients, but they can't work if they are not taken reliably, a concept called "adherence". Our goal is to gain a better understanding of the complexities of adherence to find effective ways to help patients be more adherent to OACs, and thereby prevent the serious consequences of Afib, including stroke, death, and hospitalization. Two extremely promising areas for making such discoveries are: finding the cut-off points ("thresholds") below which nonadherence leads to serious outcomes, and 2) measuring the clinical consequences of various long-term patterns ("trajectories") of adherence that patients exhibit. To do this, we will study health data (e.g., prescriptions, physician billing records, hospital records) of all Afib patients in British Columbia since 2010 when newer OACs became available. We will study their OAC adherence to see what thresholds are most important for predicting serious outcomes. We will also study how different trajectories of adherence affect the rate of serious outcomes. Our research team includes clinicians and researchers with extensive experience working with patients with AF and doing this type of research with large population-level databases. The results of this research will help care providers, researchers, and policymakers better identify which patients are at highest risk and could benefit the most from improving their OAC adherence, design more effective programs to help patients be more adherent to their OACs, implement policies that provide the greatest benefit for patients, and do better research about all these issues in the future.