Análisis de la tendencia temporal en el mal control de los pacientes anticoagulados en una cohorte de pacientes de atención primaria

Abstract

Objective To determine the temporal trend in poorly-controlled anticoagulated patients. Material and methods A longitudinal study was conducted on a non-unselected sample of all patients seen in a health centre over a period of 3 years (2011-2013). Patients who received anti-vitamin K anticoagulation for at least 6 months due to non-valvular atrial fibrillation were selected, obtaining a final sample of 130 patients. Results The mean age of the sample was 77.0 ± 1.5 years and 53.1% were male. The prevalence of hypertension and diabetes mellitus was 90% and 33.8%, respectively, and 11.5% and 14.6% had had heart failure or a stroke, respectively. The mean number of medications taken by patients was 7.6 ± 0.6. The prevalence of insufficient control of time in therapeutic range, calculated by Rosendaal, was 60.2% in 2011, 54.2% in 2010, and 43.4% in 2012. On analysing the time in the therapeutic range in patients with impaired control in the first quarter of follow-up, it was observed to remain low in subsequent years: 69.7% vs 55%, P = .0005, in 2011; 71.9% vs 59.3%, P = .0015 in 2012; and 74.7% vs 60%, P = .0005 in 2013. Conclusions Our study shows that patients with inadequate time in therapeutic range have a tendency to stay in poor control, suggesting the need for early clinical decisions in patients on anticoagulants, taking into account the prognosis and economic costs of atrial fibrillation and treatment.