Quality of clinical documentation and anticoagulation control in patients with chronic nonvalvular atrial fibrillation in routine medical care.
OBJECTIVE
Anticoagulation quality and record documentation were retrospectively assessed in patients with chronic nonvalvular atrial fibrillation (CNVAF) managed in a routine care setting.


METHODS
Medical record data extraction from physician practices in 4 regions of the United States.


RESULTS
Of 686 patients, 59% had an electrocardiogram confirming CNVAF, 84% listed at least 1 stroke risk factor, and 60% indicated the goal target international normalized ratio (INR). Two thirds of INRs>3.0 or <2.0 had no recorded dose change, nor did 45% of INRs>5.0. Vitamin K was given (3%) or anticoagulation was temporarily discontinued (9%) for INRs>5.0. The median interval of INR testing was 21 days, which decreased to 7 days for INRs> 4.60. Patients spent 58% of the time in therapeutic range.


CONCLUSIONS
Serious deficiencies in quality and documentation of routine medical care of anticoagulation for patients with CNVAF continue to exist.
Ansell
Jack
J
Department of Medicine, Boston University, Boston, MA 02118, USA. Jack.ansell@bmc.org
Caro
J Jaime
JJ
Salas
Maribel
M
Dolor
Rowena J
RJ
Corbett
William
W
Hudnut
Andrew
A
Seyal
Saleem
S
Lordan
Noreen D
ND
Proskorovsky
Irina
I
Wygant
Gail
G
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy*; D002908:Chronic Disease; D004282:Documentation / Q000592:standards*; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control; D014481:United States; D014812:Vitamin K / Q000627:therapeutic use