Patient-Specific Tailored Intervention Improves INR Time in Therapeutic Range and INR Variability in Heart Failure Patients.
Many patients with heart failure need anticoagulants, including warfarin. Good control is particularly challenging in heart failure patients, with <60% of international normalized ratio (INR) measurements in the therapeutic range, thereby increasing the risk of complications. This study aimed to evaluate the effect of a patient-specific tailored intervention on anticoagulation control in patients with heart failure.



Patients with heart failure taking warfarin therapy (n = 145) were randomized to either standard care or a 1-time intervention assessing potential risk factors for lability of INR, in which they received patient-specific instructions. Time in therapeutic range (TTR) using Rosendaal's linear model was assessed 3 months before and after the intervention.



The patient-tailored intervention significantly increased anticoagulation control. The median TTR levels before intervention were suboptimal in the interventional and control groups (53% vs 45%, P = .14). After intervention the median TTR increased significantly in the interventional group compared with the control group (80% [interquartile range, 62%-93%] vs 44% [29%-61%], P <.0001). The intervention resulted in a significant improvement in the interventional group before versus after intervention (53% vs 80%, P <.0001) but not in the control group (45% vs 44%, P = .95). The percentage of patients with a TTR ≥60%, considered therapeutic, was substantially higher in the interventional group: 79% versus 25% (P <.0001). The INR variability (standard deviation of each patient's INR measurements) decreased significantly in the interventional group, from 0.53 to 0.32 (P <.0001) after intervention but not in the control group.



Patient-specific tailored intervention significantly improves anticoagulation therapy in patients with heart failure.
Heart Failure Center, Heart Institute, Hadassah University Hospital, Jerusalem, Israel. Electronic address: igotsman@bezeqint.net.
Israel
I
Gotsman
Heart Failure Center, Heart Institute, Hadassah University Hospital, Jerusalem, Israel; Henrietta Szold Hadassah-Hebrew University School of Nursing, Jerusalem, Israel.
Orly
O
Ezra
Heart Failure Center, Heart Institute, Hadassah University Hospital, Jerusalem, Israel; School of Pharmacy, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Bruria
B
Hirsh Raccah
Heart Failure Center, Heart Institute, Hadassah University Hospital, Jerusalem, Israel.
Dan
D
Admon
Heart Failure Center, Heart Institute, Hadassah University Hospital, Jerusalem, Israel.
Chaim
C
Lotan
Henrietta Szold Hadassah-Hebrew University School of Nursing, Jerusalem, Israel.
Freda
F
Dekeyser Ganz
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D016903:Drug Monitoring / Q000379:methods / Q000592:standards*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D019934:International Normalized Ratio / Q000592:standards*; D007557:Israel; D016014:Linear Models; D008297:Male; D057285:Precision Medicine / Q000379:methods / Q000592:standards*; D013997:Time Factors; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin
Heart failure; INR; Tailored intervention