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Group-based Trajectory Models to Assess Quality of INR Control and Its Association With Clinical Outcomes

The Time in Therapeutic Range (TTR) is the gold-standard measure used to assess the quality of oral anticoagulation with vitamin K antagonists. However, TTR is a static measure, and International Normalized Ratio (INR) control is a dynamic process. Group-based Trajectory Models (GBTM) can address th...

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Autores principales: García-Sempere, Aníbal, Hurtado, Isabel, Bejarano, Daniel, Santa-Ana, Yared, Rodríguez-Bernal, Clara, Peiró, Salvador, Sanfélix-Gimeno, Gabriel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069412/
https://www.ncbi.nlm.nih.gov/pubmed/31764479
http://dx.doi.org/10.1097/MLR.0000000000001253
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author García-Sempere, Aníbal
Hurtado, Isabel
Bejarano, Daniel
Santa-Ana, Yared
Rodríguez-Bernal, Clara
Peiró, Salvador
Sanfélix-Gimeno, Gabriel
author_facet García-Sempere, Aníbal
Hurtado, Isabel
Bejarano, Daniel
Santa-Ana, Yared
Rodríguez-Bernal, Clara
Peiró, Salvador
Sanfélix-Gimeno, Gabriel
author_sort García-Sempere, Aníbal
collection PubMed
description The Time in Therapeutic Range (TTR) is the gold-standard measure used to assess the quality of oral anticoagulation with vitamin K antagonists. However, TTR is a static measure, and International Normalized Ratio (INR) control is a dynamic process. Group-based Trajectory Models (GBTM) can address this dynamic nature by classifying patients into different trajectories of INR control over time. OBJECTIVES: The objective of this study was to assess the quality of INR control in a population-based cohort of new users of vitamin K antagonist with a diagnosis of atrial fibrillation using GBTM. METHODS: We classified patients into different trajectories according to their propensity for being adequately anticoagulated over their first year of treatment using GBTM, and we evaluated the association between trajectories and relevant clinical outcomes over the following year. RESULTS: We included 8024 patients in the cohort who fulfilled the inclusion criteria; the mean number of INR determinations over the first year of treatment was 13.9. We identified 4 differential trajectories of INR control: Optimal (9.7% of patients, TTR: 83.8%), Improving (27.4% of patients, TTR: 61.2%), Worsening (28%; TTR: 69.1%), and Poor control (34.9%; TTR: 41.5%). In adjusted analysis, Poor and Worsening control patients had a higher risk of death than Optimal control patients (hazard ratio: 1.79; IC 95%, 1.36–2.36 and hazard ratio: 1.36; IC 95%, 1.02–1.81, respectively). Differences in other outcomes did not achieve statistical significance, except for a reduced risk of transient ischemic attack in the Improving Control group. CONCLUSIONS: GBTM may contribute to a better understanding and assessment of the quality of oral anticoagulation and may be used in addition to traditional, well-established measures such as TTR.
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spelling pubmed-70694122020-03-25 Group-based Trajectory Models to Assess Quality of INR Control and Its Association With Clinical Outcomes García-Sempere, Aníbal Hurtado, Isabel Bejarano, Daniel Santa-Ana, Yared Rodríguez-Bernal, Clara Peiró, Salvador Sanfélix-Gimeno, Gabriel Med Care Online Article: Applied Methods The Time in Therapeutic Range (TTR) is the gold-standard measure used to assess the quality of oral anticoagulation with vitamin K antagonists. However, TTR is a static measure, and International Normalized Ratio (INR) control is a dynamic process. Group-based Trajectory Models (GBTM) can address this dynamic nature by classifying patients into different trajectories of INR control over time. OBJECTIVES: The objective of this study was to assess the quality of INR control in a population-based cohort of new users of vitamin K antagonist with a diagnosis of atrial fibrillation using GBTM. METHODS: We classified patients into different trajectories according to their propensity for being adequately anticoagulated over their first year of treatment using GBTM, and we evaluated the association between trajectories and relevant clinical outcomes over the following year. RESULTS: We included 8024 patients in the cohort who fulfilled the inclusion criteria; the mean number of INR determinations over the first year of treatment was 13.9. We identified 4 differential trajectories of INR control: Optimal (9.7% of patients, TTR: 83.8%), Improving (27.4% of patients, TTR: 61.2%), Worsening (28%; TTR: 69.1%), and Poor control (34.9%; TTR: 41.5%). In adjusted analysis, Poor and Worsening control patients had a higher risk of death than Optimal control patients (hazard ratio: 1.79; IC 95%, 1.36–2.36 and hazard ratio: 1.36; IC 95%, 1.02–1.81, respectively). Differences in other outcomes did not achieve statistical significance, except for a reduced risk of transient ischemic attack in the Improving Control group. CONCLUSIONS: GBTM may contribute to a better understanding and assessment of the quality of oral anticoagulation and may be used in addition to traditional, well-established measures such as TTR. Lippincott Williams & Wilkins 2020-04 2019-11-19 /pmc/articles/PMC7069412/ /pubmed/31764479 http://dx.doi.org/10.1097/MLR.0000000000001253 Text en Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Online Article: Applied Methods
García-Sempere, Aníbal
Hurtado, Isabel
Bejarano, Daniel
Santa-Ana, Yared
Rodríguez-Bernal, Clara
Peiró, Salvador
Sanfélix-Gimeno, Gabriel
Group-based Trajectory Models to Assess Quality of INR Control and Its Association With Clinical Outcomes
title Group-based Trajectory Models to Assess Quality of INR Control and Its Association With Clinical Outcomes
title_full Group-based Trajectory Models to Assess Quality of INR Control and Its Association With Clinical Outcomes
title_fullStr Group-based Trajectory Models to Assess Quality of INR Control and Its Association With Clinical Outcomes
title_full_unstemmed Group-based Trajectory Models to Assess Quality of INR Control and Its Association With Clinical Outcomes
title_short Group-based Trajectory Models to Assess Quality of INR Control and Its Association With Clinical Outcomes
title_sort group-based trajectory models to assess quality of inr control and its association with clinical outcomes
topic Online Article: Applied Methods
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069412/
https://www.ncbi.nlm.nih.gov/pubmed/31764479
http://dx.doi.org/10.1097/MLR.0000000000001253
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