National Assessment of Warfarin Anticoagulation Therapy for Stroke Prevention in Atrial Fibrillation
BACKGROUND—Anticoagulation control with warfarin, as assessed by the international normalized ratio (INR), is challenging. Time in the therapeutic range has been inversely correlated with major hemorrhage, thrombosis, and mortality. Quest Diagnostics offers standardized INR laboratory testing servic...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2014-04, Vol.129 (13), p.1407-1414 |
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| container_title | Circulation (New York, N.Y.) |
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| creator | Dlott, Jeffrey S George, Roberta A Huang, Xiaohua Odeh, Mouneer Kaufman, Harvey W Ansell, Jack Hylek, Elaine M |
| description | BACKGROUND—Anticoagulation control with warfarin, as assessed by the international normalized ratio (INR), is challenging. Time in the therapeutic range has been inversely correlated with major hemorrhage, thrombosis, and mortality. Quest Diagnostics offers standardized INR laboratory testing services to approximately half of US physician practices. To inform national stroke prevention strategies, we evaluated anticoagulation control in office-based community practices.
METHODS AND RESULTS—We selected individuals with ≥2 months of INR data, INR results of >1.2, and an ICD-9 diagnosis code of atrial fibrillation. Frequency of INR testing and time in the therapeutic range were analyzed by age, sex, length of testing period, number of referred patients per provider, and median household income (based on home ZIP code). We identified 138 319 individuals referred by 37 939 physicians, yielding a total of 2 683 674 INR results. Patients had a mean age of 74 years; 81% were ≥65 years of age, and 55% were ≥75 years of age. The mean time in the therapeutic range was 53.7% overall and improved with time on treatment, increasing from 47.6% for patients with |
| doi_str_mv | 10.1161/CIRCULATIONAHA.113.002601 |
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METHODS AND RESULTS—We selected individuals with ≥2 months of INR data, INR results of >1.2, and an ICD-9 diagnosis code of atrial fibrillation. Frequency of INR testing and time in the therapeutic range were analyzed by age, sex, length of testing period, number of referred patients per provider, and median household income (based on home ZIP code). We identified 138 319 individuals referred by 37 939 physicians, yielding a total of 2 683 674 INR results. Patients had a mean age of 74 years; 81% were ≥65 years of age, and 55% were ≥75 years of age. The mean time in the therapeutic range was 53.7% overall and improved with time on treatment, increasing from 47.6% for patients with <6 months of testing to 57.5% for those with ≥6 months of testing (P<0.0001). The number of patients tested per physician practice was positively associated with time in the therapeutic range. Younger age, female sex, and lower income were also independently associated with poorer anticoagulant control.
CONCLUSION—This study demonstrates widespread suboptimal anticoagulation control, suggesting an urgent need to improve oral anticoagulation care for most patient segments in the United States.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.113.002601</identifier><identifier>PMID: 24493817</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: by the American College of Cardiology Foundation and the American Heart Association, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anticoagulants - therapeutic use ; Atrial Fibrillation - complications ; Atrial Fibrillation - epidemiology ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood. Blood coagulation. Reticuloendothelial system ; Cardiac dysrhythmias ; Cardiology. Vascular system ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Female ; Follow-Up Studies ; Heart ; Humans ; International Normalized Ratio ; Male ; Medical sciences ; Middle Aged ; Neurology ; Pharmacology. Drug treatments ; Regression Analysis ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stroke - epidemiology ; Stroke - prevention & control ; Time Factors ; Treatment Outcome ; United States - epidemiology ; Vascular diseases and vascular malformations of the nervous system ; Warfarin - therapeutic use</subject><ispartof>Circulation (New York, N.Y.), 2014-04, Vol.129 (13), p.1407-1414</ispartof><rights>2014 by the American College of Cardiology Foundation and the American Heart Association, Inc.</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5181-5c680a0958a88e82cfbc97528f6fe911a17ca2457ceab7c90254b2fcd367d693</citedby><cites>FETCH-LOGICAL-c5181-5c680a0958a88e82cfbc97528f6fe911a17ca2457ceab7c90254b2fcd367d693</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28428343$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24493817$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dlott, Jeffrey S</creatorcontrib><creatorcontrib>George, Roberta A</creatorcontrib><creatorcontrib>Huang, Xiaohua</creatorcontrib><creatorcontrib>Odeh, Mouneer</creatorcontrib><creatorcontrib>Kaufman, Harvey W</creatorcontrib><creatorcontrib>Ansell, Jack</creatorcontrib><creatorcontrib>Hylek, Elaine M</creatorcontrib><title>National Assessment of Warfarin Anticoagulation Therapy for Stroke Prevention in Atrial Fibrillation</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>BACKGROUND—Anticoagulation control with warfarin, as assessed by the international normalized ratio (INR), is challenging. Time in the therapeutic range has been inversely correlated with major hemorrhage, thrombosis, and mortality. Quest Diagnostics offers standardized INR laboratory testing services to approximately half of US physician practices. To inform national stroke prevention strategies, we evaluated anticoagulation control in office-based community practices.
METHODS AND RESULTS—We selected individuals with ≥2 months of INR data, INR results of >1.2, and an ICD-9 diagnosis code of atrial fibrillation. Frequency of INR testing and time in the therapeutic range were analyzed by age, sex, length of testing period, number of referred patients per provider, and median household income (based on home ZIP code). We identified 138 319 individuals referred by 37 939 physicians, yielding a total of 2 683 674 INR results. Patients had a mean age of 74 years; 81% were ≥65 years of age, and 55% were ≥75 years of age. The mean time in the therapeutic range was 53.7% overall and improved with time on treatment, increasing from 47.6% for patients with <6 months of testing to 57.5% for those with ≥6 months of testing (P<0.0001). The number of patients tested per physician practice was positively associated with time in the therapeutic range. Younger age, female sex, and lower income were also independently associated with poorer anticoagulant control.
CONCLUSION—This study demonstrates widespread suboptimal anticoagulation control, suggesting an urgent need to improve oral anticoagulation care for most patient segments in the United States.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants - therapeutic use</subject><subject>Atrial Fibrillation - complications</subject><subject>Atrial Fibrillation - epidemiology</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood. Blood coagulation. Reticuloendothelial system</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology. Vascular system</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Humans</subject><subject>International Normalized Ratio</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Pharmacology. Drug treatments</subject><subject>Regression Analysis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Stroke - epidemiology</subject><subject>Stroke - prevention & control</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United States - epidemiology</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><subject>Warfarin - therapeutic use</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkM1u1DAURi0EokPhFVBYILFJ8W9iL1hEI0pHGrUIBrGMbjzXjGkmntoJVd8eDxlA7FhZvj7n-tNHyCtGLxir2Nvl6tPyy7rZrG6um6smz8QFpbyi7BFZMMVlKZUwj8mCUmrKWnB-Rp6l9D1fK1Grp-SMS2mEZvWCbK9h9GGAvmhSwpT2OIxFcMVXiA6iH4pmGL0N8G3qf4HFZocRDg-FC7H4PMZwi8XHiD-ydnw9CmP0ed2l76LvZ-k5eeKgT_jidJ6TzeX7zfKqXN98WC2bdWkV06xUttIUqFEatEbNreusqRXXrnJoGANWW-BS1Rahq62hXMmOO7sVVb2tjDgnb-a1hxjuJkxju_fJYg4xYJhSyxTjnGthZEbNjNoYUoro2kP0e4gPLaPtseP2347zTLRzx9l9efpm6va4_WP-LjUDr08AJAu9izBYn_5yWuYQUmTu3czdh37EmG776R5ju0Pox91_BPkJJYeauA</recordid><startdate>20140401</startdate><enddate>20140401</enddate><creator>Dlott, Jeffrey S</creator><creator>George, Roberta A</creator><creator>Huang, Xiaohua</creator><creator>Odeh, Mouneer</creator><creator>Kaufman, Harvey W</creator><creator>Ansell, Jack</creator><creator>Hylek, Elaine M</creator><general>by the American College of Cardiology Foundation and the American Heart Association, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140401</creationdate><title>National Assessment of Warfarin Anticoagulation Therapy for Stroke Prevention in Atrial Fibrillation</title><author>Dlott, Jeffrey S ; George, Roberta A ; Huang, Xiaohua ; Odeh, Mouneer ; Kaufman, Harvey W ; Ansell, Jack ; Hylek, Elaine M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5181-5c680a0958a88e82cfbc97528f6fe911a17ca2457ceab7c90254b2fcd367d693</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anticoagulants - therapeutic use</topic><topic>Atrial Fibrillation - complications</topic><topic>Atrial Fibrillation - epidemiology</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood. Blood coagulation. Reticuloendothelial system</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology. Vascular system</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Humans</topic><topic>International Normalized Ratio</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neurology</topic><topic>Pharmacology. Drug treatments</topic><topic>Regression Analysis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Stroke - epidemiology</topic><topic>Stroke - prevention & control</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>United States - epidemiology</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><topic>Warfarin - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dlott, Jeffrey S</creatorcontrib><creatorcontrib>George, Roberta A</creatorcontrib><creatorcontrib>Huang, Xiaohua</creatorcontrib><creatorcontrib>Odeh, Mouneer</creatorcontrib><creatorcontrib>Kaufman, Harvey W</creatorcontrib><creatorcontrib>Ansell, Jack</creatorcontrib><creatorcontrib>Hylek, Elaine M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dlott, Jeffrey S</au><au>George, Roberta A</au><au>Huang, Xiaohua</au><au>Odeh, Mouneer</au><au>Kaufman, Harvey W</au><au>Ansell, Jack</au><au>Hylek, Elaine M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>National Assessment of Warfarin Anticoagulation Therapy for Stroke Prevention in Atrial Fibrillation</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2014-04-01</date><risdate>2014</risdate><volume>129</volume><issue>13</issue><spage>1407</spage><epage>1414</epage><pages>1407-1414</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>BACKGROUND—Anticoagulation control with warfarin, as assessed by the international normalized ratio (INR), is challenging. Time in the therapeutic range has been inversely correlated with major hemorrhage, thrombosis, and mortality. Quest Diagnostics offers standardized INR laboratory testing services to approximately half of US physician practices. To inform national stroke prevention strategies, we evaluated anticoagulation control in office-based community practices.
METHODS AND RESULTS—We selected individuals with ≥2 months of INR data, INR results of >1.2, and an ICD-9 diagnosis code of atrial fibrillation. Frequency of INR testing and time in the therapeutic range were analyzed by age, sex, length of testing period, number of referred patients per provider, and median household income (based on home ZIP code). We identified 138 319 individuals referred by 37 939 physicians, yielding a total of 2 683 674 INR results. Patients had a mean age of 74 years; 81% were ≥65 years of age, and 55% were ≥75 years of age. The mean time in the therapeutic range was 53.7% overall and improved with time on treatment, increasing from 47.6% for patients with <6 months of testing to 57.5% for those with ≥6 months of testing (P<0.0001). The number of patients tested per physician practice was positively associated with time in the therapeutic range. Younger age, female sex, and lower income were also independently associated with poorer anticoagulant control.
CONCLUSION—This study demonstrates widespread suboptimal anticoagulation control, suggesting an urgent need to improve oral anticoagulation care for most patient segments in the United States.</abstract><cop>Hagerstown, MD</cop><pub>by the American College of Cardiology Foundation and the American Heart Association, Inc</pub><pmid>24493817</pmid><doi>10.1161/CIRCULATIONAHA.113.002601</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Anticoagulants - therapeutic use Atrial Fibrillation - complications Atrial Fibrillation - epidemiology Biological and medical sciences Blood and lymphatic vessels Blood. Blood coagulation. Reticuloendothelial system Cardiac dysrhythmias Cardiology. Vascular system Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Female Follow-Up Studies Heart Humans International Normalized Ratio Male Medical sciences Middle Aged Neurology Pharmacology. Drug treatments Regression Analysis Retrospective Studies Risk Assessment Risk Factors Stroke - epidemiology Stroke - prevention & control Time Factors Treatment Outcome United States - epidemiology Vascular diseases and vascular malformations of the nervous system Warfarin - therapeutic use |
| title | National Assessment of Warfarin Anticoagulation Therapy for Stroke Prevention in Atrial Fibrillation |
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