Warfarin Quality Metrics for Hospitalized Older Adults
Abstract Background Warfarin's adverse drug events are dangerous, common, and costly. While outpatient warfarin management tools exist, there is a dearth of guidance for inpatients. Objectives We sought to describe a health system's chronic warfarin quality metric...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Georg Thieme Verlag KG
2018-07-01
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| Series: | TH Open |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1667138 |
| _version_ | 1818967680498008064 |
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| author | Jessica Cohen Liron Sinvani Jason J. Wang Andrzej Kozikowski Vidhi Patel Guang Qiu Renee Pekmezaris Alex C. Spyropoulos |
| author_facet | Jessica Cohen Liron Sinvani Jason J. Wang Andrzej Kozikowski Vidhi Patel Guang Qiu Renee Pekmezaris Alex C. Spyropoulos |
| author_sort | Jessica Cohen |
| collection | DOAJ |
| description | Abstract
Background Warfarin's adverse drug events are dangerous, common, and costly. While outpatient warfarin management tools exist, there is a dearth of guidance for inpatients.
Objectives We sought to describe a health system's chronic warfarin quality metrics in older inpatients, defined by international normalized ratio (INR) control, explore associations between INR overshoots and clinical outcomes, and identify factors associated with overshoots.
Patients/Methods Data on patients 65 years and older who were prescribed chronic warfarin and admitted during January 1, 2014, to June 30, 2016, were extracted through retrospective chart review. We defined overshoots as INRs 5 or greater after 48 hours of hospitalization. Logistic regression modeling was used to determine risks for overshoots and multivariate analysis for overshoots' association with length of stay (LOS), bleeding, and mortality.
Results Of the 12,107 older inpatients on chronic warfarin, most were 75 years or older (75.7%), female (51.2%), and white (70.0%). While 1,333 (11.0%) of patients had overshoots during the admission, 449 (33.7%) of these reached overshoots after 48 hours. When stratified by overshoots versus no overshoots, LOS more than doubled (15.6 vs. 6.8 days) and the bleed rate was significantly higher (27.4 vs. 8.3%) in the overshoot group. While overall mortality was small (0.4%), the overshoot group's mortality was significantly higher (3.12 vs. 0.28%). Black race and weight were protective against overshoots; history of heart failure and antibiotic/amiodarone exposure were predictive of overshoots.
Conclusion This is the largest study examining warfarin quality metrics for hospitalized adults, specifically older inpatients. Our model may serve as the basis for identifying high-risk warfarin patients to target interventions to reduce adverse drug events. |
| first_indexed | 2024-12-20T13:52:39Z |
| format | Article |
| id | doaj.art-1027a290a83a405eba23936db4b9debb |
| institution | Directory Open Access Journal |
| issn | 2512-9465 2512-9465 |
| language | English |
| last_indexed | 2024-12-20T13:52:39Z |
| publishDate | 2018-07-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | TH Open |
| spelling | doaj.art-1027a290a83a405eba23936db4b9debb2022-12-21T19:38:30ZengGeorg Thieme Verlag KGTH Open2512-94652512-94652018-07-010203e242e24910.1055/s-0038-1667138Warfarin Quality Metrics for Hospitalized Older AdultsJessica Cohen0Liron Sinvani1Jason J. Wang2Andrzej Kozikowski3Vidhi Patel4Guang Qiu5Renee Pekmezaris6Alex C. Spyropoulos7Division of Hospital Medicine, Department of Medicine, Northwell Health, Manhasset, New York, United StatesDivision of Hospital Medicine, Department of Medicine, Northwell Health, Manhasset, New York, United StatesDonald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, New York, United StatesDonald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, New York, United StatesDivision of Health Services Research, Center for Health Innovations and Outcomes Research, Department of Medicine, Northwell Health, Manhasset, New York, United StatesDivision of Hospital Medicine, Department of Medicine, Northwell Health, Manhasset, New York, United StatesDonald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, New York, United StatesDonald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Manhasset, New York, United StatesAbstract Background Warfarin's adverse drug events are dangerous, common, and costly. While outpatient warfarin management tools exist, there is a dearth of guidance for inpatients. Objectives We sought to describe a health system's chronic warfarin quality metrics in older inpatients, defined by international normalized ratio (INR) control, explore associations between INR overshoots and clinical outcomes, and identify factors associated with overshoots. Patients/Methods Data on patients 65 years and older who were prescribed chronic warfarin and admitted during January 1, 2014, to June 30, 2016, were extracted through retrospective chart review. We defined overshoots as INRs 5 or greater after 48 hours of hospitalization. Logistic regression modeling was used to determine risks for overshoots and multivariate analysis for overshoots' association with length of stay (LOS), bleeding, and mortality. Results Of the 12,107 older inpatients on chronic warfarin, most were 75 years or older (75.7%), female (51.2%), and white (70.0%). While 1,333 (11.0%) of patients had overshoots during the admission, 449 (33.7%) of these reached overshoots after 48 hours. When stratified by overshoots versus no overshoots, LOS more than doubled (15.6 vs. 6.8 days) and the bleed rate was significantly higher (27.4 vs. 8.3%) in the overshoot group. While overall mortality was small (0.4%), the overshoot group's mortality was significantly higher (3.12 vs. 0.28%). Black race and weight were protective against overshoots; history of heart failure and antibiotic/amiodarone exposure were predictive of overshoots. Conclusion This is the largest study examining warfarin quality metrics for hospitalized adults, specifically older inpatients. Our model may serve as the basis for identifying high-risk warfarin patients to target interventions to reduce adverse drug events.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1667138adverse drug eventsanticoagulantsinpatientsinrwarfarin |
| spellingShingle | Jessica Cohen Liron Sinvani Jason J. Wang Andrzej Kozikowski Vidhi Patel Guang Qiu Renee Pekmezaris Alex C. Spyropoulos Warfarin Quality Metrics for Hospitalized Older Adults TH Open adverse drug events anticoagulants inpatients inr warfarin |
| title | Warfarin Quality Metrics for Hospitalized Older Adults |
| title_full | Warfarin Quality Metrics for Hospitalized Older Adults |
| title_fullStr | Warfarin Quality Metrics for Hospitalized Older Adults |
| title_full_unstemmed | Warfarin Quality Metrics for Hospitalized Older Adults |
| title_short | Warfarin Quality Metrics for Hospitalized Older Adults |
| title_sort | warfarin quality metrics for hospitalized older adults |
| topic | adverse drug events anticoagulants inpatients inr warfarin |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1667138 |
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