The Quality of Anticoagulation Therapy among Warfarin-Treated Patients with Atrial Fibrillation in a Primary Health Care Setting
Background and objectives: Long-term therapy with oral anticoagulants is recommended for stroke prevention in patients with atrial fibrillation (AF). This study evaluated the quality of anticoagulation therapy among warfarin-treated AF patients in selected primary health care centres in Lithuania. M...
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MDPI AG
2019-01-01
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| Series: | Medicina |
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| Online Access: | http://www.mdpi.com/1010-660X/55/1/15 |
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| author | Gediminas Urbonas Leonas Valius Gintarė Šakalytė Kęstutis Petniūnas Inesa Petniūnienė |
| author_facet | Gediminas Urbonas Leonas Valius Gintarė Šakalytė Kęstutis Petniūnas Inesa Petniūnienė |
| author_sort | Gediminas Urbonas |
| collection | DOAJ |
| description | Background and objectives: Long-term therapy with oral anticoagulants is recommended for stroke prevention in patients with atrial fibrillation (AF). This study evaluated the quality of anticoagulation therapy among warfarin-treated AF patients in selected primary health care centres in Lithuania. Materials and Methods: This was a retrospective study conducted in nine primary health care centres in Lithuania. Existing medical records of randomly selected adult patients with AF who were treated with warfarin for at least 12 months were reviewed and analysed. Physicians’ decisions to adjust warfarin dose were considered as consistent with the approved warfarin posology if warfarin dose was increased in case of international normalized ratio (INR) <2.0, decreased in case of INR >3.0 or unchanged in case of INR within 2.0 to 3.0. Results: The study population included 406 patients. The mean duration of treatment with warfarin was 5.4 years. The median number of INR measurements per patient per year was 8.0. More than half (57.3%) of available INR values were outside the target range, with 13.6% INR values being above 3.0 and 43.7% INR values—below 2.0. The median time in therapeutic range (TTR) was 40.0%; only 20% of patients had TTR of ≥65%. In about 40% of the cases with INR values outside the target range, no dose corrections were implemented. About 27% of decisions on warfarin dose adjustment were not consistent with the recommended warfarin posology. The median number of INR measurements was lower among patients living in urban areas, while the median TTR was significantly higher in urban patients than in rural patients. In the multivariate regression model, gender, HAS-BLED score and warfarin treatment duration were associated with a TTR of ≥65%. Conclusions: Anticoagulation control is suboptimal in routine clinical practice with a median TTR of 40%. Our findings suggest that there might be a room for improvement of anticoagulation control in primary care. |
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| language | English |
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| publishDate | 2019-01-01 |
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| series | Medicina |
| spelling | doaj.art-cf8098adf48f451998134a4066eb62cf2023-09-02T12:12:21ZengMDPI AGMedicina1010-660X2019-01-015511510.3390/medicina55010015medicina55010015The Quality of Anticoagulation Therapy among Warfarin-Treated Patients with Atrial Fibrillation in a Primary Health Care SettingGediminas Urbonas0Leonas Valius1Gintarė Šakalytė2Kęstutis Petniūnas3Inesa Petniūnienė4Department of Family medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, LithuaniaDepartment of Family medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, LithuaniaDepartment of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, LithuaniaDepartment of Family medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, LithuaniaDepartment of Family medicine, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, LithuaniaBackground and objectives: Long-term therapy with oral anticoagulants is recommended for stroke prevention in patients with atrial fibrillation (AF). This study evaluated the quality of anticoagulation therapy among warfarin-treated AF patients in selected primary health care centres in Lithuania. Materials and Methods: This was a retrospective study conducted in nine primary health care centres in Lithuania. Existing medical records of randomly selected adult patients with AF who were treated with warfarin for at least 12 months were reviewed and analysed. Physicians’ decisions to adjust warfarin dose were considered as consistent with the approved warfarin posology if warfarin dose was increased in case of international normalized ratio (INR) <2.0, decreased in case of INR >3.0 or unchanged in case of INR within 2.0 to 3.0. Results: The study population included 406 patients. The mean duration of treatment with warfarin was 5.4 years. The median number of INR measurements per patient per year was 8.0. More than half (57.3%) of available INR values were outside the target range, with 13.6% INR values being above 3.0 and 43.7% INR values—below 2.0. The median time in therapeutic range (TTR) was 40.0%; only 20% of patients had TTR of ≥65%. In about 40% of the cases with INR values outside the target range, no dose corrections were implemented. About 27% of decisions on warfarin dose adjustment were not consistent with the recommended warfarin posology. The median number of INR measurements was lower among patients living in urban areas, while the median TTR was significantly higher in urban patients than in rural patients. In the multivariate regression model, gender, HAS-BLED score and warfarin treatment duration were associated with a TTR of ≥65%. Conclusions: Anticoagulation control is suboptimal in routine clinical practice with a median TTR of 40%. Our findings suggest that there might be a room for improvement of anticoagulation control in primary care.http://www.mdpi.com/1010-660X/55/1/15atrial fibrillationanticoagulationINRTTRwarfarinprimary care |
| spellingShingle | Gediminas Urbonas Leonas Valius Gintarė Šakalytė Kęstutis Petniūnas Inesa Petniūnienė The Quality of Anticoagulation Therapy among Warfarin-Treated Patients with Atrial Fibrillation in a Primary Health Care Setting Medicina atrial fibrillation anticoagulation INR TTR warfarin primary care |
| title | The Quality of Anticoagulation Therapy among Warfarin-Treated Patients with Atrial Fibrillation in a Primary Health Care Setting |
| title_full | The Quality of Anticoagulation Therapy among Warfarin-Treated Patients with Atrial Fibrillation in a Primary Health Care Setting |
| title_fullStr | The Quality of Anticoagulation Therapy among Warfarin-Treated Patients with Atrial Fibrillation in a Primary Health Care Setting |
| title_full_unstemmed | The Quality of Anticoagulation Therapy among Warfarin-Treated Patients with Atrial Fibrillation in a Primary Health Care Setting |
| title_short | The Quality of Anticoagulation Therapy among Warfarin-Treated Patients with Atrial Fibrillation in a Primary Health Care Setting |
| title_sort | quality of anticoagulation therapy among warfarin treated patients with atrial fibrillation in a primary health care setting |
| topic | atrial fibrillation anticoagulation INR TTR warfarin primary care |
| url | http://www.mdpi.com/1010-660X/55/1/15 |
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