title: [Control of anticoagulation in patients with non-valvular atrial fibrillation in a primary care clinical practice setting in the different autonomous communities. PAULA study].
abstract: OBJECTIVE
  To determine the differences between regions in the level of control of patients with non-valvular atrial fibrillation treated with vitamin K antagonists, included in the PAULA study.
  
  
  METHODS
  Observational, and coss-sectional/retrospective study, including 139 Primary Care physicians from 99 Health Care centres in all autonomous communities (except La Rioja). Anticoagulation control was defined as the time in therapeutic range assessed by either the direct method (poor control <60%), or the Rosendaal method (poor control <65%).
  
  
  RESULTS
  A total of 1,524 patients were included. Small differences in baseline characteristics of the patients were observed. Differences in the percentage of time in therapeutic range were observed, according to the Rosendaal method (mean 69.0±17.7%), from 78.1%±16.6 (Basque Country) to 61.5±14% (Balearic Islands), by the direct method (mean 63.2±17.9%) from 73.6%±16.6 (Basque Country) to 57.5±15.7% (Extremadura). When comparing regions, in those where the Primary Care physicians assumed full control without restrictions on prescription, the percentage of time in therapeutic range by the direct method was 63.89 vs. 60.95% in those with restrictions (p=.006), by Rosendaal method, 69.39% compared with 67.68% (p=.1036).
  
  
  CONCLUSIONS
  There are significant differences in the level of control between some regions are still inadequate. Regions in which the Primary Care physicians assumed the management of anticoagulation and without restrictions, time in therapeutic range was somewhat higher, and showed a favourable trend for better control. These findings may have clinical implications, and deserve consideration and specific analysis.
authors.affiliation: Centro de Salud Casar de Cáceres, Cáceres, España. Electronic address: jpolog@semergen.es.
authors.forename: J
authors.initials: J
authors.lastname: Polo García
authors.affiliation: Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: V
authors.initials: V
authors.lastname: Barrios Alonso
authors.affiliation: Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Escobar Cervantes
authors.affiliation: Bioestadística Médica, Universidad Católica San Antonio de Murcia (UCAM), Murcia, España.
authors.forename: L
authors.initials: L
authors.lastname: Prieto Valiente
authors.affiliation: Centro de Salud Jazmín, Área 4, Madrid, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Lobos Bejarano
authors.affiliation: Unidad de Hospitalización Polivalente, Hospital de Alta Resolución El Toyo, Hospital de Poniente El Ejido, Almería, España.
authors.forename: D
authors.initials: D
authors.lastname: Vargas Ortega
authors.affiliation: Centro de Salud Vallobín-La Florida, Área Sanitaria IV, Oviedo, España.
authors.forename: M Á
authors.initials: MÁ
authors.lastname: Prieto Díaz
authors.affiliation: Centro de Salud Sillería, Toledo, España.
authors.forename: F J
authors.initials: FJ
authors.lastname: Alonso Moreno
authors.affiliation: Centro de Salud de Trujillo, Cáceres, España.
authors.forename: A
authors.initials: A
authors.lastname: Barquilla García
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D058007:Physicians, Primary Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013030:Spain; D013997:Time Factors; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
keywords: Antagonistas vitamina K; Control INR; Fibrilación auricular no valvular; INR monitoring; Non-valvular atrial fibrillation; Rosendaal; Vitamin K antagonists