Anticoagulation Management of Atrial Fibrillation: The Relationship of Prevailing Adherence to a Dose Protocol and Recall Schedule on TTR in Primary Care

OBJECTIVE: To investigate the prevailing level of adherence to a dosing algorithm and a recall schedule and its relationship with the time in therapeutic range (TTR) among patients with atrial fibrillation. METHODS: The study was carried out at a regional primary care clinic in Malaysia. Patients on anticoagulation therapy aged older than 18 years were included in the study. The participants have received continuation of their anticoagulation therapy at the primary care clinic for at least 6 months to 1 year after being discharged from a tertiary center. Correlation and multiple regression studies were performed to determine the significance of the predictors of TTR. RESULTS: A majority (217) of patients with atrial fibrillation received anticoagulation therapy at the clinic followed by patients with mitral valve replacement and aortic valve replacement. The mean TTR for patients with atrial fibrillation was 57.6%. General practitioners (GPs) adhered to 75.5% of the dose protocol but fared poorly in adhering to the recall schedule (36.2%). The concordance to the dose algorithm and recall schedule were significantly related to TTR. Multiple regression analysis proved that the concordance to the dose algorithm and recall schedule were important predictors of the level of TTR in patients with atrial fibrillation. DISCUSSION: The study provides preliminary evidence on the relationship between a validated dose algorithm that is integrated with a recall schedule in the control of TTR in patients with atrial fibrillation on anticoagulation treatment. A larger multicenter study is needed to confirm the results of this finding.