Anticoagulation for valvular heart disease in community-based practice.

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Oral anticoagulation is crucial for valvular heart disease (VHD) and atrial fibrillation (AF).
• Limited data exists on VHD patients receiving anticoagulation in community settings.
• Understanding VHD anticoagulation management and outcomes is vital for patient care.

Purpose of the Study:

• To characterize patients anticoagulated for VHD compared to AF.
• To assess management and clinical outcomes in these patient groups.
• To identify differences in anticoagulation control and bleeding events.

Main Methods:

• Utilized a nationally-representative US cohort of community-based anticoagulation care.
• Collected data on indications, demographics, comorbidities, INR targets, INR control, and outcomes.
• Compared 1,057 VHD patients with 3,396 AF patients.

Main Results:

• VHD patients constituted 15.6% of the anticoagulated cohort.
• INR variability was similar between VHD and AF groups (0.64 vs. 0.69).
• VHD patients experienced a higher rate of major hemorrhage (3.57 vs. 1.78 events/100 patient-years).
• Stroke/systemic embolus rates were similar between groups (0.67 vs. 0.97 events/100 patient-years).
• A majority of aortic VHD patients (84%) were on a higher INR target range (2.5-3.5) than recommended (2-3).

Conclusions:

• Community-based anticoagulation for VHD is common, representing 15.6% of patients.
• Anticoagulation control, measured by INR variability, is comparable between VHD and AF patients.
• VHD patients exhibit a significantly higher rate of major hemorrhage, warranting further investigation.
• Discrepancies in target INR ranges for aortic VHD suggest potential management issues.