National Assessment of Warfarin Anticoagulation Therapy for Stroke Prevention in Atrial Fibrillation
National Assessment of Warfarin Anticoagulation Therapy for Stroke Prevention in Atrial Fibrillation
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DOI：
10.1161/circulationaha.113.002601
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发表时间：
2014-04-01
期刊：
影响因子：
37.8
通讯作者：
Hylek, Elaine M.
中科院分区：
文献类型：
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作者：
Dlott, Jeffrey S.;George, Roberta A.;Hylek, Elaine M.
背景：华法林抗凝控制（通过国际标准化比值（INR）评估）具有挑战性。治疗范围内的时间与大出血、血栓形成和死亡率呈负相关。Quest Diagnostics为大约一半的美国医生提供标准化INR实验室检测服务。为了为国家中风预防策略提供信息，我们评估了基于办公室的社区实践中的抗凝控制。方法和结果我们选择了具有2个月INR数据、INR结果>1.2且ICD-9诊断代码为房颤的个体。INR测试的频率和治疗范围内的时间通过年龄、性别、测试期的长度、每个提供者的转诊患者数量和家庭收入中位数（基于家庭邮政编码）进行分析。我们确定了由37939名医生推荐的138319名患者，共产生2683674个INR结果。患者的平均年龄为74岁; 81%的患者年龄为65岁，55%的患者年龄为75岁。总体而言，治疗范围内的平均时间为53.7%，并随着治疗时间的延长而改善，
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