Control de la anticoagulación en pacientes con fibrilación auricular no valvular en práctica clínica de atención primaria en las diferentes comunidades autónomas. Estudio PAULA
- J. Polo García 8
- V. Barrios Alonso 9
- C. Escobar Cervantes 1
- L. Prieto Valiente 2
- J.M. Lobos Bejarano 3
- D. Vargas Ortega 4
- M.Á. Prieto Díaz 5
- F.J. Alonso Moreno 6
- A. Barquilla García 7
- 1 Hospital Universitario La Paz, Madrid, España
- 2 Universidad Católica San Antonio de Murcia (UCAM), Murcia, España
- 3 Centro de Salud Jazmín, Área 4, Madrid, España
- 4 Hospital de Poniente El Ejido, Almería, España
- 5 Centro de Salud Vallobín-La Florida, Área Sanitaria IV, Oviedo, España
- 6 Centro de Salud Sillería, Toledo, España
- 7 Centro de Salud de Trujillo, Cáceres, España
- 8 Centro de Salud Casar de Cáceres, Cáceres, España
- 9 Hospital Universitario Ramón y Cajal, Madrid, España
ISSN: 1138-3593
Année de publication: 2017
Número: 3
Pages: 207-215
Type: Article
D'autres publications dans: Semergen: revista española de medicina de familia
Objectifs de Développement Durable
Résumé
Aims 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.