Anticoagulant treatment of patients with atrial fibrillation in primary health care.
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.
Available from: Ingela Björholt
- "The figures were somewhat lower when initiating treatment, as expected. Our figures on monitoring episodes within the therapeutic range (71.5%) are in line with or are higher than figures reported in recent studies [23-26]. The proportion of time spent in the therapeutic range (70.2%) is higher than the figures mentioned above (47–51%) [27,22]. "
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ABSTRACT: Chronic atrial fibrillation is a prevalent cardiac disorder. The literature indicates varying proportions of those treated with anticoagulants, and varying intensity of anticoagulation. Electronic patient records are providing us with clinical data concerning management of anticoagulant treatment in real-life practice that is useful for audits. We aimed to assess warfarin treatment for chronic atrial fibrillation in primary health care with regard to prevalence, incidence, the proportion treated and the quality of anticoagulation control.
Five primary health care centres in Stockholm with a registered population of 75146 participated in a one-year retrospective study of electronic patient records up until May 2000. All patients over 18 years of age with an encounter labelled 'Atrial fibrillation' were identified, and all records of patients on warfarin treatment were manually reviewed. Main outcome measures were number of patients with chronic atrial fibrillation, number of patients on wafarin treatment, and time within the therapeutic prothrombin range.
In total, 419 patients had chronic atrial fibrillation, giving a prevalence of 0.60% (age-adjusted 0.62%), the age group 65 years or older accounted for 91.6%, and 50.1% were women. Out of these, 50.4% (211 patients) were established on warfarin treatment for chronic atrial fibrillation (0.28% of the population), and there was a predominance of men (p = 0.02). Fifty-four patients started treatment with warfarin for chronic atrial fibrillation (0.07% of the population). Among 25 randomly selected patients on established treatment, the proportion of time within the therapeutic range was 70.2%. Among 24 randomly selected patients starting treatment, the proportion of time with therapeutic values was 54.2% and 66.9% the first and second months of treatment, respectively.
Chronic atrial fibrillation is common among the elderly in primary health care, and about half of these patients are treated with warfarin. It appears to be under-diagnosed, and may also be under-treated. About two thirds of treatment time is spent within the therapeutic range, and further improvement of the quality of anticoagulation control with warfarin may therefore be hard to achieve.
BMC Clinical Pharmacology 03/2004; 4(1):1. DOI:10.1186/1472-6904-4-1 · 1.36 Impact Factor
Available from: Per Wändell
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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 · 2.97 Impact Factor
FMC - Formación Médica Continuada en Atención Primaria 01/2003; 10(5):323–329. DOI:10.1016/S1134-2072(03)75907-6
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