title: Point-of-care monitoring of warfarin treatment in community dwelling elderly--A randomised controlled study.
abstract: The objective of this study was to assess clinical effectiveness and costs of launching point-of-care monitoring of warfarin treatment in community dwelling frail elderly patients. A prospective multicentre controlled randomised study over 12 months comparing a point-of-care strategy with usual monitoring routines was carried out in primary healthcare centres and anticoagulation clinics in southeast Sweden. The subjects were community dwelling elderly across rural southeast Sweden on chronic warfarin treatment. Main outcome measures were time in therapeutic range (TTR), rate of treatment-related adverse events and costs. The study comprised 103 elderly people (61% women) mean age 86 yrs (range 75-98) treated with warfarin for median 9 yrs (range 1-18). Patients randomised to start point-of-care monitoring (n = 55) showed 75.9% in TTR before trial vs. 72.6% during trial (ns). The patients randomised to continue on usual monitoring routines (n = 48) showed 75.2% in TTR prior to trial vs. 72.9% during trial (ns). The point-of-care monitoring showed potential savings of SEK 624 per patient annually (based partly on effects that were not statistically significant). The study shows that point-of-care monitoring of warfarin treatment in community dwelling elderly in rural areas is as effective as usual monitoring routines and that it may offer savings to society.
authors.affiliation: Center for Medical Technology Assessment, Linköping University, Linköping thomas.davidson@liu.se.
authors.forename: Thomas
authors.initials: T
authors.lastname: Davidson
authors.affiliation: Local health Care Services, in East Östergötland.
authors.forename: Ann
authors.initials: A
authors.lastname: Lindelöf
authors.affiliation: Department of Internal medicine, Västervik hospital.
authors.forename: Torbjörn
authors.initials: T
authors.lastname: Wallén
authors.affiliation: Department of Clinical and Experimental Medicine, Linköping University and Clinical Chemistry, Linköping University Hospital, Linköping.
authors.forename: Tomas L
authors.initials: TL
authors.lastname: Lindahl
authors.affiliation: Local health Care Services, in East Östergötland.
authors.forename: Claes
authors.initials: C
authors.lastname: Hallert
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D008297:Male; D019095:Point-of-Care Systems / Q000191:economics / Q000592:standards*; D011446:Prospective Studies; D011788:Quality of Life; D013548:Sweden; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin