Document Detail


Quality of anticoagulation monitoring in nonvalvular atrial fibrillation patients: comparison of anticoagulation clinic versus usual care.
MedLine Citation:
PMID:  18094348     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Prior research suggests that receiving specialized anticoagulation services enables patients to achieve better clinical outcomes. OBJECTIVE: To assess the quality of anticoagulation therapy in patients with atrial fibrillation who were enrolled in an anticoagulation clinic (ACC) versus usual care (UC). METHODS: Using Sharp Rees-Stealy physician group claims data, we estimated time spent in therapeutic range and time to first major bleeding episode or stroke for ACC and UC patients. t-Tests were used to compare time in therapeutic range proportions, and Kaplan-Meier survival analysis was performed to compare rates of bleeding and stroke between groups. RESULTS: We identified 1107 patients (351 ACC, 756 UC) treated with anticoagulation therapy for atrial fibrillation with more than one international normalized ratio (INR) reported between March 2001 and March 2004. ACC patients spent a greater proportion (68.14%) of time in therapeutic range compared with UC patients (42.07%; p < 0.001). There was a significant difference between groups in average time between INR tests (ACC = 14.31 days, UC = 18.39 days; p < 0.001). ACC patients were 59% less likely to experience a bleed following the index date than were UC patients (HR = 0.41; 95% CI 0.2444 to 0.6999; p = 0.001), but type of care was not a significant predictor for stroke (HR = 0.95; 95% CI 0.5125 to 1.7777; p value NS). CONCLUSIONS: Results from this observational study reinforce the positive impact that anticoagulation services have on anticoagulation therapy outcomes, emphasizing the importance of providing such services for patients undergoing treatment with warfarin.
Authors:
Michael B Nichol; Tara K Knight; Tom Dow; Gail Wygant; Gerald Borok; Ole Hauch; Richard O'Connor
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-12-19
Journal Detail:
Title:  The Annals of pharmacotherapy     Volume:  42     ISSN:  1542-6270     ISO Abbreviation:  Ann Pharmacother     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-07     Completed Date:  2008-01-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203131     Medline TA:  Ann Pharmacother     Country:  United States    
Other Details:
Languages:  eng     Pagination:  62-70     Citation Subset:  IM    
Affiliation:
Department of Clinical Pharmacy and Pharmaceutical Economics & Policy, University of Southern California, Los Angeles, CA 90033, USA. mnichol@usc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Ambulatory Care Facilities
Anticoagulants / adverse effects,  therapeutic use*
Atrial Fibrillation / drug therapy*
Cohort Studies
Drug Monitoring / methods*
Female
Hemorrhage / chemically induced
Humans
International Normalized Ratio
Kaplan-Meiers Estimate
Male
Middle Aged
Quality of Health Care*
Retrospective Studies
Stroke / prevention & control
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anticoagulants

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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