Assessment of Degree of Anticoagulation Control in Patients With Atrial Fibrillation in Primary Health Care in Galicia, Spain: ANFAGAL Study

Introduction and objectives: To determine the degree of control of patients on anticoagulants in follow-up in primary care in Galicia and investigate whether time in therapeutic range as estimated using the number of acceptable controls is comparable with the estimation using the Rosendaal method. Methods: Transversal study that included patients older than 65 years, diagnosed with nonvalvular atrial fibrillation, on anticoagulants for at least 1 year. Control was considered good when the time in therapeutic range was greater than 65%, estimated by the Rosendaal method, or 60% estimated by the number of acceptable controls. Results: We enrolled 511 patients (53.0% women; mean [standard deviation] age, 77.8 [0.6] years). Overall, 41.5% of the patients were in therapeutic range at fewer than 60% of the controls and 42.7% spent less than 65% of follow-up in therapeutic range, as estimated with the Rosendaal method. In the group of patients with poor control, we observed more drugs (6.8 [0.4] vs 5.7 [0.3]; P < .0001), greater presence of kidney disease (24.3% vs 17.0%; P = .05), and higher HAS-BLED scores (3.8 [0.1] vs 2.5 [0.1]; P < .0001). The cutoff of 60% for number of acceptable controls had a sensitivity and specificity of 79.4% and 86.7%, respectively, with an area under the curve of 0.92 (95% CI, 0.87-0.97). Conclusions: More than 40% of patients on anticoagulants do not reach the minimum time in therapeutic range to benefit from anticoagulation. The factors associated with worse control were kidney disease and high risk of cerebral hemorrhage. The 2 methods of estimation are comparable. (C) 2014 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.