TY - JOUR
T1 - Patients' time in therapeutic range on warfarin among US patients with atrial fibrillation
T2 - Results from ORBIT-AF registry
AU - Pokorney, Sean D.
AU - Simon, Dajuanicia N.
AU - Thomas, Laine
AU - Fonarow, Gregg C.
AU - Kowey, Peter R.
AU - Chang, Paul
AU - Singer, Daniel E.
AU - Ansell, Jack
AU - Blanco, Rosalia G.
AU - Gersh, Bernard
AU - Mahaffey, Kenneth W.
AU - Hylek, Elaine M.
AU - Go, Alan S.
AU - Piccini, Jonathan P.
AU - Peterson, Eric D.
N1 - Funding Information:
D.N.H., L.T., R.G.B., and A.S.G. report no disclosures. S.D.P. reports modest educational grant support from Astra Zeneca and modest advisory board to Janssen Pharmaceuticals. G.C.F. reports modest consultant/advisory board support from Janssen Pharmaceuticals. P.R.K. reports modest consultant/advisory board support from Boehringer Ingelheim, Bristol-Myers Squibb, Johnson & Johnson, Portola, Merck, Sanofi, and Daiichi Sankyo. P.C. reports significant employment with Johnson & Johnson. D.E.S. reports significant consulting fees from Bayer Healthcare, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Johnson & Johnson, Pfizer, and CSL Behring; significant research grant from Johnson & Johnson. J.A. reports modest consultant/advisory board: Boehringer Ingelheim, Alere, Bristol-Myers Squibb, Pfizer, Janssen, and Daiichi. B.G. reports modest Data and Safety Monitoring Board/advisory board support from Medtronic, Baxter Healthcare Corporation, InspireMD, Cardiovascular Research Foundation, PPD Development, LP, Boston Scientific, and St. Jude. K.W.M. financial disclosures before August 1, 2013, can be viewed at https://www.dcri.org/about-us/conflict-of-interest/Mahaffey-COI_2011-2013.pdf ; disclosures after August 1, 2013, can be viewed at http://med.stanford.edu/profiles/kenneth_mahaffey . E.M.H. reports modest honoraria from Boehringer Ingelheim and Bayer and modest consultant/advisory board from Daiichi Sankyo, Ortho-McNeil-Janssen, Johnson & Johnson, Boehringer Ingelheim, Bristol-Myers Squibb, Roche, and Pfizer. J.P.P. reports significant research grant support from Johnson & Johnson/Janssen Pharmaceuticals; significant other research support from Bayer HealthCare Pharmaceuticals Inc (formerly Berlex Labs), Boston Scientific Corporation, Johnson & Johnson Pharmaceutical Research & Development; modest Consultant/Advisory Board support from Forest Laboratories, Inc and Medtronic, Inc; and significant Consultant/Advisory Board support from Johnson & Johnson/Janssen Pharmaceuticals. E.D.P. reports significant research grant support from Eli Lilly & Company, Janssen Pharmaceuticals, Inc, and the American Heart Association; modest consultant/advisory board support from Boehringer Ingelheim, Bristol-Myers Squibb, Janssen Pharmaceuticals, Inc, Pfizer, and Genentech Inc.
Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/7/1
Y1 - 2015/7/1
N2 - Background Time in therapeutic range (TTR) of international normalized ratio (INR) of 2.0 to 3.0 is important for the safety and effectiveness of warfarin anticoagulation. There are few data on TTR among patients with atrial fibrillation (AF) in community-based clinical practice. Methods Using the US Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), we examined TTR (using a modified Rosendaal method) among 5,210 patients with AF on warfarin and treated at 155 sites. Patients were grouped into quartiles based on TTR data. Multivariable logistic regression modeling with generalized estimating equations was used to determine patient and provider factors associated with the lowest (worst) TTR. Results Overall, 59% of the measured INR values were between 2.0 and 3.0, with an overall mean and median TTR of 65% ± 20% and 68% (interquartile range [IQR] 53%-79%). The median times below and above the therapeutic range were 17% (IQR 8%-29%) and 10% (IQR 3%-19%), respectively. Patients with renal dysfunction, advanced heart failure, frailty, prior valve surgery, and higher risk for bleeding (ATRIA score) or stroke (CHA2DS2-VASc score) had significantly lower TTR (P <.0001 for all). Patients treated at anticoagulation clinics had only slightly higher median TTR (69%) than those not (66%) (P <.0001). Conclusions Among patients with AF in US clinical practices, TTR on warfarin is suboptimal, and those at highest predicted risks for stroke and bleeding were least likely to be in therapeutic range.
AB - Background Time in therapeutic range (TTR) of international normalized ratio (INR) of 2.0 to 3.0 is important for the safety and effectiveness of warfarin anticoagulation. There are few data on TTR among patients with atrial fibrillation (AF) in community-based clinical practice. Methods Using the US Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), we examined TTR (using a modified Rosendaal method) among 5,210 patients with AF on warfarin and treated at 155 sites. Patients were grouped into quartiles based on TTR data. Multivariable logistic regression modeling with generalized estimating equations was used to determine patient and provider factors associated with the lowest (worst) TTR. Results Overall, 59% of the measured INR values were between 2.0 and 3.0, with an overall mean and median TTR of 65% ± 20% and 68% (interquartile range [IQR] 53%-79%). The median times below and above the therapeutic range were 17% (IQR 8%-29%) and 10% (IQR 3%-19%), respectively. Patients with renal dysfunction, advanced heart failure, frailty, prior valve surgery, and higher risk for bleeding (ATRIA score) or stroke (CHA2DS2-VASc score) had significantly lower TTR (P <.0001 for all). Patients treated at anticoagulation clinics had only slightly higher median TTR (69%) than those not (66%) (P <.0001). Conclusions Among patients with AF in US clinical practices, TTR on warfarin is suboptimal, and those at highest predicted risks for stroke and bleeding were least likely to be in therapeutic range.
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U2 - 10.1016/j.ahj.2015.03.017
DO - 10.1016/j.ahj.2015.03.017
M3 - Article
C2 - 26093875
AN - SCOPUS:84931574254
SN - 0002-8703
VL - 170
SP - 141-148.e1
JO - American heart journal
JF - American heart journal
IS - 1
ER -