title: Quality of life (QoL) and International Normalized Ratio (INR) control of patients attending anticoagulation clinics.
abstract: OBJECTIVE
  To investigate association between quality of life (QoL) and International Normalized Ratio (INR) control, with the secondary aim of assessing QoL using generic and anticoagulation-specific, the Short Form Health Survey (SF-12) and the Duke Anticoagulation Satisfaction Scale (DASS).
  
  
  METHODS
  This study assessed anticoagulation related QoL at three time intervals in two groups of patients on long-term warfarin therapy.
  
  
  METHODS
  Data of 326 randomly sampled patients (163 patients each in DASS and SF-12 groups) who had been on warfarin therapy for at least one year at anticoagulation clinics were analysed. QoL was assessed at three time intervals: at the start, six months and one year of warfarin therapy. Indications and target INR ranges and subjects INR values were recorded. Time in Therapeutic Range (TTR) was estimated for four subject subgroups, based on target ranges of INR for clustered indications.
  
  
  RESULTS
  Of the total, 43% of the subjects were aged between 50 and 64 years, and 51% were female. DASS assessed subjects older than 35 years perceived significant decrease in overall mean scores of anticoagulation related QoL, whilst all SF-12 assessed subjects perceived an increase in QoL. The mean percentage days in range for all INR target range subgroups did not exceed more than 60% but there was only a weak correlation (Rs = 0.104, P > 0.05) between INR control and overall QoL.
  
  
  CONCLUSIONS
  Malaysian urban outpatients on warfarin treatment longer than one year report a significant overall decrease in QoL, as measured using a validated condition-specific instrument. These patients appeared to adapt well to lifestyle limitations imposed by long-term anticoagulation.
authors.affiliation: The University of Queensland, 20 Cornwall Street, Woolloongabba 4102, Queensland, Australia. Electronic address: shahzad_pharmacy@yahoo.com.
authors.forename: S S
authors.initials: SS
authors.lastname: Hasan
authors.affiliation: International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia. Electronic address: teh_khai_mei@hotmail.com.
authors.forename: K M
authors.initials: KM
authors.lastname: Teh
authors.affiliation: International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia. Electronic address: sia194@yahoo.com.
authors.forename: S I
authors.initials: SI
authors.lastname: Ahmed
authors.affiliation: Monash University, Sunway Campus Malaysia, Jalan Lagoon Selatan, Bandar Sunway 46150, Malaysia. Electronic address: david.chong@med.monash.edu.my.
authors.forename: D W K
authors.initials: DW
authors.lastname: Chong
authors.affiliation: International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia. Electronic address: ohchin87@yahoo.com.
authors.forename: H C
authors.initials: HC
authors.lastname: Ong
authors.affiliation: General Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur 50586, Malaysia. Electronic address: basariahnaina@yahoo.com.
authors.forename: B
authors.initials: B
authors.lastname: Naina
mesh_terms: D000284:Administration, Oral; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods; D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use; D044466:Asian People / Q000523:psychology*; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology; D011788:Quality of Life; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Anticoagulation therapy; International Normalized Ratio; Quality of life