APOLLO I: Anticoagulation control in atrial fibrillation.

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Effective anticoagulation control, measured by time in therapeutic range (TTR), is crucial for the safety and efficacy of thromboprophylaxis in atrial fibrillation (AF).
• Assessing TTR and identifying factors influencing it are essential for optimizing patient outcomes in anticoagulation management.

Purpose of the Study:

• To evaluate the TTR achieved in patients with atrial fibrillation at the Family Health Unit of Fânzeres.
• To investigate the sociodemographic and clinical determinants associated with better anticoagulation control.

Main Methods:

• A case series study involving 106 eligible patients with atrial fibrillation treated with warfarin or acenocoumarol.
• TTR was calculated using the Rosendaal method based on International Normalized Ratio (INR) tests from the preceding six months.
• Statistical analysis included descriptive statistics, Spearman's correlation, and Mann-Whitney U/Kruskal-Wallis tests using SPSS 21.0.

Main Results:

• A median TTR of 65.3% was observed in the study population (n=74).
• A significant positive association was found between TTR and the duration of atrial fibrillation (ρ=0.477, p<0.001) and duration of anticoagulation (ρ=0.5, p<0.001).
• No significant association was found between TTR and age, gender, educational level, or the presence of a caregiver.

Conclusions:

• The median TTR in this unit is comparable to other Southern European regions and approaches the European Society of Cardiology's recommended threshold of 70%.
• The duration of AF and anticoagulation only partially explain the variability in TTR, indicating other factors are at play.
• Future research should explore additional determinants of anticoagulation control and consider comparative studies within family health units that manage anticoagulation internally.