Anticoagulant treatment of patients with atrial fibrillation in primary health care.
ABSTRACT To determine the prevalence of anticoagulant (AC) treatment of patients with atrial fibrillation in primary health care. To identify complications in the same patients during 1 year.
Cross-sectional study and 1-year follow-up.
Seven health centres with a total population of 164093.
Five hundred and twenty-two anticoagulated patients with atrial fibrillation.
The age-adjusted prevalence of AC treated patients with atrial fibrillation was 0.30%. Of the 522 patients, 240 were men, mean age 69.6 years; and 282 women, mean age 75.1 years. At the beginning of the study 85% and after 1 year 81% of the latest prothrombin time values were within recommended range. After 1 year 414 out of the 522 patients continued AC treatment. During the 1-year follow-up 62 patients had minor or major complications. Eleven patients (2.1%) had to discontinue AC treatment because of complications. Prothrombin tests were mainly taken at 3-4 week intervals.
High quality AC treatment is possible in the hands of general practitioners.
[Show abstract] [Hide abstract]
ABSTRACT: The well-known predictors for increased early deaths after spontaneous intracerebral hemorrhage (ICH) include the clinical and radiological severity of bleeding as well as being on a warfarin regimen at the onset of stroke. Ischemic heart disease and atrial fibrillation may also increase early deaths. In the present study the authors aimed to elucidate the role of the last 2 factors. The authors assessed the 3-month mortality rate in patients with spontaneous ICH (453 individuals) who were admitted to the stroke unit of Oulu University Hospital within a period of 11 years (1993-2004). The 3-month mortality rate for the 453 patients was 28%. The corresponding mortality rates were 42% for the patients who had ischemic heart disease and 61% for those with atrial fibrillation on admission. The following independent predictors of death emerged after adjustment for sex and the use of warfarin or aspirin at the onset of ICH: 1) ischemic heart disease (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.12-2.48, p < 0.02); 2) atrial fibrillation on admission (HR 1.79, 95% CI 1.12-2.86, p < 0.02); 3) the Glasgow Coma Scale score on admission (HR 0.82 per unit, 95% CI 0.79-0.87, p < 0.01); 4) size of hematoma (HR 1.11 per 10 ml, 95% CI 1.07-1.16, p < 0.01); 5) intraventricular hemorrhage (HR 2.62, 95% CI 1.71-4.02, p < 0.01); 6) age (HR 1.04 per year, 95% CI 1.02-1.06, p < 0.01); and 7) infratentorial location of the hematoma (HR 1.93, 95% CI 1.26-2.97, p < 0.01). Both ischemic heart disease and atrial fibrillation independently and significantly impaired the 3-month survival of patients with ICH.Journal of Neurosurgery 06/2008; 108(6):1172-7. DOI:10.3171/JNS/2008/108/6/1172 · 3.23 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Objective: Assessing the quality of anticoagulant (AC) treatment in primary health care with regard to safety. Design: Surveys of patients on AC treatment during 1999. Setting: Community health centres (CHCs) in the north-eastern region of Stockholm County. Subjects: Nine hundred and fifty-seven patients, from 16 CHCs. Main outcome measures: Rate of bleeding and thrombo-embolic events during AC treatment and rate of values within the recommended treatment interval. The reporting of prothrombin-time (PT) results changed during the year from PT values to international normalised ratio (INR). Results: A total of 48 bleeding events in 44 patients were noted, i.e. 6.8 per 100 patient-years. Of these, ten were major bleedings, 1.4 per 100 patient-years, including three fatal bleedings, 0.4 per 100 patient-years. Six thrombo-embolic events were noted during treatment, i.e. 0.8 per 100 patient-years. Bleeding events were more common at INR values greater than 2.80 than at values of 2.80, [relative risk (RR) 3.30, 95% confidence interval 1.90-5.71]. Of all the noted PT values, 65% were within the recommended intervals (the most common being PT 15-25%) and of all noted INR values 60% (the most common being INR 2.1-3.0). No differences in the rate of bleeding or the number of thrombo-embolic events between the periods of PT and INR results were found. Conclusions: The rate of complications was low and AC treatment in primary health care seems to be as safe as in hospital clinics.European Journal of Clinical Pharmacology 03/2001; 57(1):61-64. DOI:10.1007/s002280000250 · 2.70 Impact Factor
FMC - Formación Médica Continuada en Atención Primaria 01/2003; 10(5):323–329. DOI:10.1016/S1134-2072(03)75907-6