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Anticoagulation control and cost of monitoring of older patients on chronic warfarin therapy in three settings in North East England

Lookup NU author(s): Salah Abohelaika, Professor Farhad Kamali, Dr Peter Avery, Dr Patrick Kesteven, Dr Hilary Wynne

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Abstract

Background: novel oral anticoagulants may be particularly cost-effective when INR control (TTR) with warfarin is poor or monitoring difficult.Setting: the Newcastle upon Tyne monitoring service, set in hospital or general practice and a domiciliary-based service for housebound patients.Objectives: to examine anticoagulation stability and costs of monitoring.Subjects: three hundred and twenty-six atrial fibrillation patients, 75 years and over, with target INR of two to three, accessing hospital (n = 100), general practice (n = 122) and domiciliary (n = 104) service.Methods: age, co-morbidities, length of warfarin treatment, medications, INR values and dose changes from January to December 2011 were recorded, and costs analysed.Results: home-monitored patients had taken warfarin for longer, mean 5.2 years, than hospital (3.7) or general practice (3.1) patients. Age and total number of drugs prescribed chronically were negatively related to TTR. INR measurements and dose changes were negatively associated with the duration of treatment, positively correlated with co-morbidities. The mean TTR was 78% in hospital, 71% in general practice and 68% in domiciliary monitored patients. INR was monitored more often in hospital and domiciliary groups than in general practice and more dose changes occurred in the domiciliary group than in others. Costs of warfarin and monitoring were 128 pound per patient per year for hospital, 126 pound for general practice and 222 pound for domiciliary patients.Conclusions: further exploration of the clinical effectiveness of novel anticoagulants in dependent patients is warranted to determine to what extent trial outcomes so far achieved in a fitter elderly population are influenced by the chronic co-morbidities of old age.

Publication metadata

Author(s): Abohelaika S, Kamali F, Avery P, Robinson B, Kesteven P, Wynne H

Publication type: Article

Publication status: Published

Journal: Age and Ageing

Year: 2014

Volume: 43

Issue: 5

Pages: 708-711

Print publication date: 01/09/2014

Online publication date: 18/06/2014

Acceptance date: 22/01/2014

ISSN (print): 0002-0729

ISSN (electronic): 1468-2834

Publisher: Oxford University Press

URL: http://dx.doi.org/10.1093/ageing/afu074

DOI: 10.1093/ageing/afu074

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