{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T18:10:07Z","timestamp":1748023807430,"version":"3.41.0"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Daiichi-Sankyo UK Ltd"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>This real-world study investigated the patient-related factors, characteristics, and outcomes of adult patients with non-valvular atrial fibrillation (NVAF) receiving a direct oral anticoagulant (DOAC) for secondary stroke prevention. This was a multi-centre, mixed-methods, non-interventional study conducted in 8 UK secondary care National Health Service centres. The study included adult patients who presented with first ischaemic stroke associated with NVAF without previous anticoagulants. Group 1 included all patients. Group 2 is comprised of prospectively enrolled patients who were initiated on apixaban (n\u2009=\u200949), edoxaban (n\u2009=\u200939) or rivaroxaban (n\u2009=\u20095) post-first stroke from Group 1. The primary objective (Group 1) was to describe patients\u2019 demographics, clinical characteristics, and medical history, stratified by the anticoagulant prescribed. The secondary objectives (Group 2) were to describe the patient management pathways, hospital resource use and clinical assessments associated with DOAC treatment, and the patient-reported satisfaction and experience of DOAC treatment. 234 patients were recruited from 8 centres (Group 1). Baseline CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>-VASc risk scores ranged from 2\u20137; 70% (157\/224) had a score of \u22654. 86% (n\u2009=\u2009202\/234) of patients presented with stroke at accident and emergency. For Group 2, the median time from stroke to first DOAC dose was 6 (IQR, 2.0\u201310.2; n\u2009=\u200988) days; 50% patients had\u2009\u2265\u20091 outpatient visit recorded related to AF or DOACs. At 3 and 6 months, 73% (46\/63) and 83% (43\/52) had high (score of 8) Morisky Medication Adherence Scale score (MMAS-8), respectively. No patients reported being dissatisfied at 3 or 6 months post-DOAC initiation. The study findings demonstrate high levels of adherence, persistence, and treatment satisfaction in the 6 months post-initiation of DOAC after first stroke attributable to NVAF in patients. The presented results provide clinicians with valuable insights into the experience of post-stroke patients with NVAF receiving treatment with a DOAC for secondary prevention of stroke during the 6 months post-stroke.<\/jats:p>","DOI":"10.1371\/journal.pone.0321621","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T17:36:13Z","timestamp":1748021773000},"page":"e0321621","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-world management, resource use, patient-reported outcomes and adherence in patients receiving direct oral anticoagulants for first stroke attributed to non-valvular atrial fibrillation in secondary care: A UK mixed-methods observational study"],"prefix":"10.1371","volume":"20","author":[{"given":"James","family":"Uprichard","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liqun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anand","family":"Dixit","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaqoob","family":"Bhat","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amit","family":"Mistri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dipankar","family":"Dutta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Khalid","family":"Rashed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dumin","family":"Karunatilake","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"Hatton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joe","family":"Eva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amelia","family":"Reed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,5,23]]},"reference":[{"issue":"3","key":"pone.0321621.ref001","first-page":"257","article-title":"Atrial fibrillation: the most common arrhythmia","volume":"27","author":"CR Wyndham","year":"2000","journal-title":"Tex Heart Inst J"},{"issue":"18","key":"pone.0321621.ref002","doi-asserted-by":"crossref","first-page":"2370","DOI":"10.1001\/jama.285.18.2370","article-title":"Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the anticoagulation and risk factors in atrial fibrillation (ATRIA) study","volume":"285","author":"A Go","year":"2001","journal-title":"JAMA"},{"issue":"5","key":"pone.0321621.ref003","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1093\/europace\/eus366","article-title":"Prevalence of unknown atrial fibrillation in patients with risk factors","volume":"15","author":"A Samol","year":"2013","journal-title":"Europace"},{"key":"pone.0321621.ref004","article-title":"Oral anticoagulants for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis, and cost effectiveness analysis","volume":"359","author":"J L\u00f3pez-L\u00f3pez","year":"2017","journal-title":"BMJ"},{"key":"pone.0321621.ref005","author":"Stroke Association","year":"2018"},{"issue":"7","key":"pone.0321621.ref006","doi-asserted-by":"crossref","DOI":"10.1016\/S0002-9149(98)00583-9","article-title":"Prevalence incidence prognosis and predisposing conditions for atrial fibrillation: population-based estimates 1","volume":"82","author":"W Kannel","year":"1998","journal-title":"Am J Cardiol"},{"issue":"6","key":"pone.0321621.ref007","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1016\/j.jacc.2003.11.028","article-title":"Comparing the guidelines: anticoagulation therapy to optimize stroke prevention in patients with atrial fibrillation","volume":"43","author":"SG Rockson","year":"2004","journal-title":"J Am Coll Cardiol"},{"key":"pone.0321621.ref008","author":"National Institute for Health and Care Excellence","year":"2021"},{"issue":"6","key":"pone.0321621.ref009","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.1161\/STROKEAHA.110.609297","article-title":"Improving Stroke Risk Stratification Using the CHADS2 and CHA2DS2-VASc Risk Scores in Patients With Paroxysmal Atrial Fibrillation by Continuous Arrhythmia Burden Monitoring","volume":"42","author":"G Boriani","year":"2011","journal-title":"Stroke"},{"key":"pone.0321621.ref010","author":"National Institute for Health and Care Excellence"},{"key":"pone.0321621.ref011","author":"National Institute for Health and Care Excellence"},{"key":"pone.0321621.ref012","author":"National Institute for Health and Care Excellence"},{"key":"pone.0321621.ref013","author":"National Institute for Health and Care Excellence"},{"issue":"1","key":"pone.0321621.ref014","article-title":"Temporal trends in antithrombotic treatment of real-world UK patients with newly diagnosed atrial fibrillation: findings from the GARFIELD-AF registry","volume":"8","author":"UK GARFIELD-AF Investigators and GARFIELD-AF Steering Committee","year":"2018","journal-title":"BMJ Open"},{"key":"pone.0321621.ref015","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.ahj.2017.08.011","article-title":"International trends in clinical characteristics and oral anticoagulation treatment for patients with atrial fibrillation: Results from the GARFIELD-AF, ORBIT-AF I, and ORBIT-AF II registries","volume":"194","author":"BA Steinberg","year":"2017","journal-title":"Am Heart J"},{"issue":"3","key":"pone.0321621.ref016","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1136\/heartjnl-2022-321377","article-title":"Trends in direct oral anticoagulant (doac) prescribing in english primary care (2014\u20132019)","volume":"109","author":"M Joy","year":"2023","journal-title":"Heart"},{"issue":"2","key":"pone.0321621.ref017","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1007\/s12325-022-02368-y","article-title":"Direct oral anticoagulant (DOAC) dosing in patients with non-valvular atrial fibrillation (NVAF) in the United Kingdom: A retrospective cohort study using CPRD Gold database","volume":"40","author":"A Khachatryan","year":"2023","journal-title":"Adv Ther"},{"key":"pone.0321621.ref018","author":"NHS England"},{"issue":"4","key":"pone.0321621.ref019","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1161\/CIRCULATIONAHA.121.056355","article-title":"Direct Oral Anticoagulants Versus Warfarin in Patients With Atrial Fibrillation: Patient-Level Network Meta-Analyses of Randomized Clinical Trials With Interaction Testing by Age and Sex","volume":"145","author":"AP Carnicelli","year":"2022","journal-title":"Circulation"},{"issue":"8","key":"pone.0321621.ref020","doi-asserted-by":"crossref","first-page":"6879","DOI":"10.3390\/ijms24086879","article-title":"Challenges of anticoagulant therapy in atrial fibrillation\u2014focus on gastrointestinal bleeding","volume":"24","author":"A Scridon","year":"2023","journal-title":"Int J Mol Sci"},{"key":"pone.0321621.ref021","article-title":"Effectiveness and safety of under or over-dosing of direct oral anticoagulants in atrial fibrillation: A systematic review and meta-analysis of 148909 patients from 10 real-world studies","volume":"12","author":"NN Shen","year":"2021","journal-title":"Front Pharmacol"},{"issue":"6","key":"pone.0321621.ref022","article-title":"Representativeness of the dabigatran, apixaban and rivaroxaban clinical trial populations to real-world atrial fibrillation patients in the United Kingdom: a cross-sectional analysis using the General Practice Research Database","volume":"2","author":"S Lee","year":"2012","journal-title":"BMJ Open"},{"issue":"6","key":"pone.0321621.ref023","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1160\/TH17-01-0068","article-title":"Effectiveness and safety of apixaban versus warfarin in non-valvular atrial fibrillation patients in \u201creal-world\u201d clinical practice: A propensity-matched analysis of 76,940 patients","volume":"117","author":"X Li","year":"2017","journal-title":"Thromb Haemost"},{"issue":"14","key":"pone.0321621.ref024","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1093\/eurheartj\/ehv466","article-title":"XANTUS: a real-world, prospective, observational study of patients treated with rivaroxaban for stroke prevention in atrial fibrillation","volume":"37","author":"AJ Camm","year":"2016","journal-title":"Eur Heart J"},{"key":"pone.0321621.ref025","doi-asserted-by":"crossref","DOI":"10.1093\/ehjcvp\/pvaa079","article-title":"Edoxaban for stroke prevention in atrial fibrillation in routine clinical care: 1-year follow-up of the prospective observational ETNA-AF-Europe study","volume":"7","author":"JR de Groot","year":"2021","journal-title":"Eur Heart J Cardiovasc Pharmacother"},{"issue":"1","key":"pone.0321621.ref026","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1186\/s12883-019-1530-0","article-title":"A mixed methodology, non-interventional study to evaluate the use of direct oral anticoagulants in UK clinical practice for patients with a first stroke associated with non-valvular atrial fibrillation: study protocol","volume":"19","author":"Y Bhat","year":"2019","journal-title":"BMC Neurol"},{"issue":"5","key":"pone.0321621.ref027","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1111\/j.1751-7176.2008.07572.x","article-title":"Predictive validity of a medication adherence measure in an outpatient setting","volume":"10","author":"DE Morisky","year":"2008","journal-title":"J Clin Hypertens (Greenwich)"},{"issue":"1","key":"pone.0321621.ref028","first-page":"59","article-title":"New medication adherence scale versus pharmacy fill rates in seniors with hypertension","volume":"15","author":"M Krousel-Wood","year":"2009","journal-title":"Am J Manag Care"},{"issue":"3","key":"pone.0321621.ref029","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.jclinepi.2010.09.002","article-title":"Improving the measurement of self-reported medication nonadherence: response to authors","volume":"64","author":"DE Morisky","year":"2011","journal-title":"J Clin Epidemiol"},{"issue":"9","key":"pone.0321621.ref030","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1111\/jch.14718","article-title":"Retraction Statement: Predictive validity of a medication adherence measure in an outpatient setting","volume":"25","year":"2023","journal-title":"J Clin Hypertens (Greenwich)"},{"key":"pone.0321621.ref031","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1477-7525-2-12","article-title":"Validation of a general measure of treatment satisfaction, the Treatment Satisfaction Questionnaire for Medication (TSQM), using a national panel study of chronic disease","volume":"2","author":"MJ Atkinson","year":"2004","journal-title":"Health Qual Life Outcomes"},{"key":"pone.0321621.ref032","doi-asserted-by":"crossref","first-page":"105","DOI":"10.2147\/PPA.S148697","article-title":"Comparison of claims vs patient-reported adherence measures and associated outcomes among patients with nonvalvular atrial fibrillation using oral anticoagulant therapy","volume":"12","author":"JJ Stephenson","year":"2018","journal-title":"Patient Prefer Adherence"},{"issue":"1","key":"pone.0321621.ref033","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1186\/s12872-019-1144-x","article-title":"Characteristics of patients initiated on edoxaban in Europe: baseline data from edoxaban treatment in routine clinical practice for patients with atrial fibrillation (AF) in Europe (ETNA-AF-Europe)","volume":"19","author":"R De Caterina","year":"2019","journal-title":"BMC Cardiovasc Disord"},{"issue":"12","key":"pone.0321621.ref034","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0166218","article-title":"Patient-reported treatment satisfaction with rivaroxaban for stroke prevention in atrial fibrillation: a French observational study, the SAFARI study","volume":"11","author":"O Hanon","year":"2016","journal-title":"PLoS One"},{"issue":"7","key":"pone.0321621.ref035","first-page":"777","article-title":"The changing landscape for stroke prevention in AF: findings from the GLORIA-AF registry phase 2","volume":"69","author":"M Huisman","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"pone.0321621.ref036","author":"National Institute for Health and Care Excellence","year":"2010"},{"issue":"9","key":"pone.0321621.ref037","doi-asserted-by":"crossref","first-page":"2525","DOI":"10.1161\/STROKEAHA.113.001927","article-title":"Noninvasive cardiac event monitoring to detect atrial fibrillation after ischemic stroke: a randomized, controlled trial","volume":"44","author":"P Higgins","year":"2013","journal-title":"Stroke"},{"issue":"3","key":"pone.0321621.ref038","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1177\/14782715221120133","article-title":"Improving detection and management of atrial fibrillation after ischaemic stroke in Glasgow (IMPROVE-AF): a quality improvement project","volume":"52","author":"FC Johnston","year":"2022","journal-title":"J R Coll Physicians Edinb"},{"key":"pone.0321621.ref039","author":"Royal College of Physicians","year":"2016"},{"issue":"14","key":"pone.0321621.ref040","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1161\/CIRCULATIONAHA.122.060666","article-title":"Early Versus Delayed Non-Vitamin K Antagonist Oral Anticoagulant Therapy After Acute Ischemic Stroke in Atrial Fibrillation (TIMING): A Registry-Based Randomized Controlled Noninferiority Study","volume":"146","author":"J Oldgren","year":"2022","journal-title":"Circulation"},{"issue":"2","key":"pone.0321621.ref041","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1136\/jnnp-2021-327236","article-title":"Early versus late start of direct oral anticoagulants after acute ischaemic stroke linked to atrial fibrillation: an observational study and individual patient data pooled analysis","volume":"93","author":"GM De Marchis","year":"2022","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"26","key":"pone.0321621.ref042","doi-asserted-by":"crossref","first-page":"2411","DOI":"10.1056\/NEJMoa2303048","article-title":"Early versus Later Anticoagulation for Stroke with Atrial Fibrillation","volume":"388","author":"U Fischer","year":"2023","journal-title":"N Engl J Med"},{"issue":"5","key":"pone.0321621.ref043","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1177\/17474930211057722","article-title":"Optimal timing of anticoagulation after acute ischemic stroke with atrial fibrillation (OPTIMAS): Protocol for a randomized controlled trial","volume":"17","author":"JG Best","year":"2022","journal-title":"Int J Stroke"},{"key":"pone.0321621.ref044","doi-asserted-by":"crossref","first-page":"100222","DOI":"10.1016\/j.lanepe.2021.100222","article-title":"Antithrombotic therapy in patients with liver disease: population-based insights on variations in prescribing trends, adherence, persistence and impact on stroke and bleeding","volume":"10","author":"WH Chang","year":"2021","journal-title":"Lancet Reg Health Eur"},{"issue":"8","key":"pone.0321621.ref045","first-page":"1056","article-title":"Comparing total medical expenditure between patients receiving direct oral anticoagulants vs warfarin for the treatment of atrial fibrillation: evidence from VA-Medicare dual enrollees","volume":"27","author":"ES Wong","year":"2021","journal-title":"J Manag Care Spec Pharm"},{"key":"pone.0321621.ref046","doi-asserted-by":"crossref","first-page":"849474","DOI":"10.3389\/fcvm.2022.849474","article-title":"Cost-effectiveness of Direct Oral Anticoagulant vs. Warfarin Among Atrial Fibrillation Patients With Intermediate Stroke Risk","volume":"9","author":"JH Choi","year":"2022","journal-title":"Front Cardiovasc Med"},{"issue":"9","key":"pone.0321621.ref047","first-page":"669","article-title":"Medication adherence to direct anticoagulants in patients with non-valvular atrial fibrillation - A real world analysis","volume":"40","author":"C Br\u00edzido","year":"2021","journal-title":"Rev Port Cardiol (Engl Ed)"},{"issue":"11","key":"pone.0321621.ref048","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1016\/j.cjco.2021.06.015","article-title":"Satisfaction With Oral Anticoagulants Among Patients With Atrial Fibrillation: A Prospective Observational Study","volume":"3","author":"S Salmasi","year":"2021","journal-title":"CJC Open"},{"key":"pone.0321621.ref049","doi-asserted-by":"crossref","first-page":"79","DOI":"10.2147\/PPA.S131158","article-title":"Real-life experience of quality of life, treatment satisfaction, and adherence in patients receiving oral anticoagulants for atrial fibrillation","volume":"12","author":"M Benzimra","year":"2018","journal-title":"Patient Prefer Adherence"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0321621","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T17:36:26Z","timestamp":1748021786000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0321621"}},"subtitle":[],"editor":[{"given":"Redoy","family":"Ranjan","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,23]]},"references-count":49,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0321621","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,23]]}}}