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Relation of quality of anticoagulation control with different management systems among patients with atrial fibrillation: Data from FANTASIIA Registry
Author(s) -
Roldán Rabadán Inmaculada,
EstevePastor María Asunción,
AnguitaSánchez Manuel,
Muñiz Javier,
Camacho Siles José,
Quesada María Angustias,
Ruiz Ortiz Martín,
Marín Francisco,
Martínez Sellés Manuel,
Bertomeu Vicente,
Lip Gregory Y.H.,
Cequier Fillat Angel,
Badimón Lina
Publication year - 2018
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12910
Subject(s) - medicine , atrial fibrillation , population , cardioversion , cardiology , heart failure , warfarin , environmental health
Background Anticoagulation 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 ( VKA s) in relation to the responsible specialist in a “real‐world” AF population. Methods We 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 GP s or haematologists). Results Data on 1584 patients were included (42.5% females, mean age 74.0 ± 9.4 years): 977 (61.7%) patients were controlled by GP s and 607 (38.3%) by haematologists. Patients managed by GP s 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 ± 21.4 mL/min, P < .001) compared to patients managed by haematologists. There was no difference between groups in the type of AF , CHA 2 DS 2 ‐ VAS c 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 GP s (63 ± 24.4 vs 59.2 ± 25.6, P < .005). Conclusions About 60% of AF patients anticoagulated with VKA s had poor anticoagulation control (ie TTR <70%), and their management was only slightly better than when it is managed by general practitioners.