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The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
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Published on: February 28, 2012

Quality of anticoagulation control among patients with atrial fibrillation

Osnat C Melamed1, Gilad Horowitz, Asher Elhayany

  • 1Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. osnatt@gmail.com

The American Journal of Managed Care
|April 21, 2011
PubMed

Insights

Anticoagulation control in atrial fibrillation (AF) patients was poor, with two-thirds having suboptimal time in therapeutic range (TTR). Female sex, older age, and heart failure were linked to worse warfarin control.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Atrial fibrillation (AF) management requires effective anticoagulation to prevent stroke.
  • Warfarin is a common anticoagulant, but achieving and maintaining a therapeutic international normalized ratio (INR) can be challenging.
  • Optimizing anticoagulation control is crucial for patient outcomes in managed care settings.

Purpose of the Study:

  • To evaluate the quality of anticoagulation control in patients with atrial fibrillation (AF) receiving standard care.
  • To identify patient-specific factors associated with suboptimal anticoagulation management.

Main Methods:

  • Retrospective cross-sectional study of 906 AF patients treated with warfarin for at least six months.
  • Analysis of data from Clalit Health Services (CHS) computerized database, including demographics, comorbidities, and international normalized ratio (INR) values.
  • Assessment of anticoagulation control using time within therapeutic range (TTR) and multivariate analysis to identify predictors of poor control.

Main Results:

  • Suboptimal anticoagulation control (TTR <60%) was observed in approximately two-thirds of patients, with a mean TTR of 48.6%.
  • Poor control was significantly associated with female sex, advanced age, and the presence of comorbidities.
  • Heart failure and treatment by a non-board-certified physician were independent predictors of poor anticoagulation control.

Conclusions:

  • The quality of anticoagulation in routine AF care within this managed care organization was suboptimal.
  • A significant proportion of patient time was spent outside the desired therapeutic INR range.
  • Strategies to enhance anticoagulation management in AF patients are warranted.
Abstract

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