title: Quality of clinical documentation and anticoagulation control in patients with chronic nonvalvular atrial fibrillation in routine medical care.
abstract: 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.
authors.affiliation: Department of Medicine, Boston University, Boston, MA 02118, USA. Jack.ansell@bmc.org
authors.forename: Jack
authors.initials: J
authors.lastname: Ansell
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Caro
authors.forename: Maribel
authors.initials: M
authors.lastname: Salas
authors.forename: Rowena J
authors.initials: RJ
authors.lastname: Dolor
authors.forename: William
authors.initials: W
authors.lastname: Corbett
authors.forename: Andrew
authors.initials: A
authors.lastname: Hudnut
authors.forename: Saleem
authors.initials: S
authors.lastname: Seyal
authors.forename: Noreen D
authors.initials: ND
authors.lastname: Lordan
authors.forename: Irina
authors.initials: I
authors.lastname: Proskorovsky
authors.forename: Gail
authors.initials: G
authors.lastname: Wygant
mesh_terms: 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