[Control of anticoagulation in patients with non-valvular atrial fibrillation in a primary care clinical practice setting in the different autonomous communities. PAULA study].

Abstract

AIMS:

To determine the differences between regions in the level of control of patients with non-valvular atrial fibrillation treated with vitamin K antagonists, included in the PAULA study.

METHODS:

Observational, and coss-sectional/retrospective study, including 139 Primary Care physicians from 99 Health Care centres in all autonomous communities (except La Rioja). Anticoagulation control was defined as the time in therapeutic range assessed by either the direct method (poor control <60%), or the Rosendaal method (poor control <65%).

RESULTS:

A total of 1,524 patients were included. Small differences in baseline characteristics of the patients were observed. Differences in the percentage of time in therapeutic range were observed, according to the Rosendaal method (mean 69.0±17.7%), from 78.1%±16.6 (Basque Country) to 61.5±14% (Balearic Islands), by the direct method (mean 63.2±17.9%) from 73.6%±16.6 (Basque Country) to 57.5±15.7% (Extremadura). When comparing regions, in those where the Primary Care physicians assumed full control without restrictions on prescription, the percentage of time in therapeutic range by the direct method was 63.89 vs. 60.95% in those with restrictions (p=.006), by Rosendaal method, 69.39% compared with 67.68% (p=.1036).

CONCLUSIONS:

There are significant differences in the level of control between some regions are still inadequate. Regions in which the Primary Care physicians assumed the management of anticoagulation and without restrictions, time in therapeutic range was somewhat higher, and showed a favourable trend for better control. These findings may have clinical implications, and deserve consideration and specific analysis.

• Authors: J Polo García, V Barrios Alonso, C Escobar Cervantes, L Prieto Valiente, J M Lobos Bejarano, D Vargas Ortega, M Á Prieto Díaz, F J Alonso Moreno, A Barquilla García
• Journal: Semergen (Semergen) Vol. 43 Issue 3 Pg. 207-215 (Apr 2017) ISSN: 1578-8865 [Electronic] Spain
• Vernacular Title: Control de la anticoagulación en pacientes con fibrilación auricular no valvular en práctica clínica de atención primaria en las diferentes comunidades autónomas. Estudio PAULA.
• PMID: 27422774 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Chemical References

• Anticoagulants
• Vitamin K

Topics

• Aged
• Aged, 80 and over
• Anticoagulants (therapeutic use)
• Atrial Fibrillation (drug therapy)
• Cross-Sectional Studies
• Female
• Humans
• International Normalized Ratio
• Male
• Physicians, Primary Care (statistics & numerical data)
• Primary Health Care (methods, statistics & numerical data)
• Retrospective Studies
• Spain
• Time Factors
• Vitamin K (antagonists & inhibitors)