title: The adherence to initial processes of care in elderly patients with acute venous thromboembolism.
abstract: BACKGROUND
  We aimed to assess whether elderly patients with acute venous thromboembolism (VTE) receive recommended initial processes of care and to identify predictors of process adherence.
  
  
  METHODS
  We prospectively studied in- and outpatients aged ≥65 years with acute symptomatic VTE in a multicenter cohort study from nine Swiss university- and non-university hospitals between September 2009 and March 2011. We systematically assessed whether initial processes of care, which are recommended by the 2008 American College of Chest Physicians guidelines, were performed in each patient. We used multivariable logistic models to identify patient factors independently associated with process adherence.
  
  
  RESULTS
  Our cohort comprised 950 patients (mean age 76 years). Of these, 86% (645/750) received parenteral anticoagulation for ≥5 days, 54% (405/750) had oral anticoagulation started on the first treatment day, and 37% (274/750) had an international normalized ratio (INR) ≥2 for ≥24 hours before parenteral anticoagulation was discontinued. Overall, 35% (53/153) of patients with cancer received low-molecular-weight heparin monotherapy and 72% (304/423) of patients with symptomatic deep vein thrombosis were prescribed compression stockings. In multivariate analyses, symptomatic pulmonary embolism, hospital-acquired VTE, and concomitant antiplatelet therapy were associated with a significantly lower anticoagulation-related process adherence.
  
  
  CONCLUSIONS
  Adherence to several recommended processes of care was suboptimal in elderly patients with VTE. Quality of care interventions should particularly focus on processes with low adherence, such as the prescription of continued low-molecular-weight heparin therapy in patients with cancer and the achievement of an INR ≥2 for ≥24 hours before parenteral anticoagulants are stopped.
authors.affiliation: Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
authors.forename: Anna K
authors.initials: AK
authors.lastname: Stuck
authors.affiliation: Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
authors.forename: Marie
authors.initials: M
authors.lastname: Méan
authors.affiliation: CTU Bern, Department of Clinical Research, and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Limacher
authors.affiliation: Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Righini
authors.affiliation: Division of Angiology, Basel University Hospital, Basel, Switzerland.
authors.forename: Kurt
authors.initials: K
authors.lastname: Jaeger
authors.affiliation: Cantonal Hospital of Baden, Baden, Switzerland.
authors.forename: Hans-Jürg
authors.initials: HJ
authors.lastname: Beer
authors.affiliation: Emergency Department, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland.
authors.forename: Joseph
authors.initials: J
authors.lastname: Osterwalder
authors.affiliation: Department of Internal Medicine, Cantonal Hospital of Frauenfeld, Frauenfeld, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Frauchiger
authors.affiliation: Cardiovascular Research, Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland; Division of Cardiology, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Christian M
authors.initials: CM
authors.lastname: Matter
authors.affiliation: Division of Angiology, Bern University Hospital, Bern, Switzerland.
authors.forename: Nils
authors.initials: N
authors.lastname: Kucher
authors.affiliation: Division of Diabetology, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Egloff
authors.affiliation: Division of Angiology, Basel University Hospital, Basel, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Aschwanden
authors.affiliation: Clinic of Angiology, Zurich University Hospital, Zurich, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Husmann
authors.affiliation: University Clinic of Hematology and Hematology Central Laboratory, Bern University Hospital, Bern, Switzerland.
authors.forename: Anne
authors.initials: A
authors.lastname: Angelillo-Scherrer
authors.affiliation: Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Rodondi
authors.affiliation: Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
authors.forename: Drahomir
authors.initials: D
authors.lastname: Aujesky
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007297:Inpatients; D008297:Male; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications; D010045:Outpatients; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D053828:Stockings, Compression; D013997:Time Factors; D054556:Venous Thromboembolism / Q000150:complications / Q000188:drug therapy* / Q000628:therapy
chemical_list: D000925:Anticoagulants