Relation of quality of anticoagulation control with different management systems among patients with atrial fibrillation: Data from FANTASIIA Registry
Por:
Rabadan, IR, Esteve-Pastor, MA, Anguita-Sanchez, M, Muniz, J, Siles, JC, Quesada, MA, Ortiz, MR, Marin, F, Selles, MM, Bertomeu, V, Lip, GYH, Fillat, AC, Badimon, L, FANTASIIA Study Investigators
Publicada:
1 may 2018
Resumen:
BackgroundAnticoagulation control in patients with atrial fibrillation (AF) has a multidisciplinary approach although is usually managed by general practitioners (GP) or haematologists. The aim of our study was to assess the quality of anticoagulation control with vitamin K antagonists (VKAs) in relation to the responsible specialist in a real-world AF population.
MethodsWe consecutively enrolled VKA anticoagulated patients included in the FANTASIIA Registry from 2013 to 2015. We analysed demographical, clinical characteristics and the quality of anticoagulation control according to the specialist responsible (ie GPs or haematologists).
ResultsData on 1584 patients were included (42.5% females, mean age 74.09.4years): 977 (61.7%) patients were controlled by GPs and 607 (38.3%) by haematologists. Patients managed by GPs had higher previous heart disease (53.2% vs 43.3%, P<.001), heart failure (32.9% vs 26.5%, P<.008) and dilated cardiomyopathy (15.2% vs 8.7%, P<.001) with better renal function (69.3 +/- 24.7 vs 63.1 +/- 21.4mL/min, P<.001) compared to patients managed by haematologists. There was no difference between groups in the type of AF, CHA(2)DS(2)-VASc or HAS-BLED scores, but patients with electrical cardioversion were more prevalent in GP group. The overall mean time in therapeutic range (TTR) assessed by Rosendaal method was 61.5 +/- 24.9%; 52.6% of patients had TTR<65% and 60% of patients had TTR<70%. TTR was significantly lower in patients controlled by haematologists than by GPs (63 +/- 24.4 vs 59.2 +/- 25.6, P<.005).
ConclusionsAbout 60% of AF patients anticoagulated with VKAs had poor anticoagulation control (ie TTR<70%), and their management was only slightly better than when it is managed by general practitioners.
Filiaciones:
Rabadan, IR:
Hosp Univ La Paz, Inst Invest La Paz IDIPAZ, Dept Cardiol, CIBER CV, Madrid, Spain
Esteve-Pastor, MA:
Hosp Clin Univ Virgen de la Arrixaca, Inst Murciano Invest Biosanitaria IMIB Arrixaca, Dept Cardiol, CIBER CV, Murcia, Spain
Anguita-Sanchez, M:
Hosp Univ Reina Sofia, Dept Cardiol, Cordoba, Spain
Muniz, J:
Univ A Coruna, Inst Univ Ciencias Salud, Inst Invest Biomed A Coruna INIBIC, CIBER CV, La Coruna, Spain
Siles, JC:
Hosp Univ La Paz, Dept Internal Med, Madrid, Spain
Quesada, MA:
Hosp Univ La Paz, Dept Internal Med, Madrid, Spain
Ortiz, MR:
Hosp Univ Reina Sofia, Dept Cardiol, Cordoba, Spain
Marin, F:
Hosp Clin Univ Virgen de la Arrixaca, Inst Murciano Invest Biosanitaria IMIB Arrixaca, Dept Cardiol, CIBER CV, Murcia, Spain
Selles, MM:
European Univ Madrid, Univ Complutense, Hosp Univ Gregorio Maranon, Dept Cardiol,CIBER CV, Madrid, Spain
Bertomeu, V:
Hosp Univ San Juan, Dept Cardiol, CIBER CV, Alicante, Spain
Lip, GYH:
Univ Birmingham, Inst Cardiovasc Sci, Birmingham, W Midlands, England
Aalborg Univ, Dept Clin Med, Aalborg Thrombosis Res Unit, Aalborg, Denmark
Fillat, AC:
Hosp Bellvitge Princeps Espanya, Dept Cardiol, CIBER CV, Barcelona, Spain
Badimon, L:
Hosp Santa Creu & Sant Pau, CSIC ICCC, Cardiovasc Res Ctr, IIB St Pau,CIBER CV, Barcelona, Spain
Green Accepted
|