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Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine
Background and objectives: Patients with heart failure (HF) often present with non-valvular atrial fibrillation and require oral anticoagulation with coumarin anticoagulants such as acenocoumarol. The objective of this study was to evaluate the relationship between time in therapeutic range (TTR) an...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069311/ https://www.ncbi.nlm.nih.gov/pubmed/33918627 http://dx.doi.org/10.3390/medicina57040365 |
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author | Martín-Sánchez, Rubén Ángel Lorenzo-Villalba, Noel Calvo-Elías, Alberto Elpidio Dubón-Peralta, Ester Emilia Chocrón-Benbunan, Cynthia Elisa Cano-de Luque, Carmen María López-García, Lidia Rivas-Molinero, María Outón-González, Cristina Marco-Martínez, Javier Calvo-Manuel, Elpidio Andres, Emmanuel Méndez-Bailón, Manuel |
author_facet | Martín-Sánchez, Rubén Ángel Lorenzo-Villalba, Noel Calvo-Elías, Alberto Elpidio Dubón-Peralta, Ester Emilia Chocrón-Benbunan, Cynthia Elisa Cano-de Luque, Carmen María López-García, Lidia Rivas-Molinero, María Outón-González, Cristina Marco-Martínez, Javier Calvo-Manuel, Elpidio Andres, Emmanuel Méndez-Bailón, Manuel |
author_sort | Martín-Sánchez, Rubén Ángel |
collection | PubMed |
description | Background and objectives: Patients with heart failure (HF) often present with non-valvular atrial fibrillation and require oral anticoagulation with coumarin anticoagulants such as acenocoumarol. The objective of this study was to evaluate the relationship between time in therapeutic range (TTR) and the risk of early readmission. Materials and Methods: A retrospective descriptive study was carried out on hospitalized patients with a diagnosis of HF between 2014 and 2018 who had adverse effects due to oral anticoagulation with acenocoumarol (underdosing, overdosing, or hemorrhage). Clinical, analytical, therapeutic, and prognostic variables were collected. TTR is defined as the duration of time in which the patient’s International Normalized Ratio (INR) values were within a desired range. Early readmission was defined as readmission within 30 days after hospital discharge. Patients were divided into two groups depending on whether or not they had a TTR less than 60% (TTR < 60%) over the 6 months prior to the adverse event. Results: In the cohort of 304 patients, the mean age was 82 years, 59.9% of the patients were female, and 54.6% had a TTR < 60%. Patients with TTR < 60% had a higher HAS-BLED score (4.04 vs. 2.59; p < 0.001) and INR (6 vs. 5.31; p < 0.05) but lower hemoglobin (11.67 vs. 12.22 g/dL; p < 0.05). TTR < 60% was associated with early readmission after multivariate analysis (OR: 2.05 (CI 95%: 1.16–3.61)). They also had a higher percentage of hemorrhagic events and in-hospital mortality but without reaching statistical significance. Conclusions: Patients with HF and adverse events due to acenocoumarol often have poor INR control, which is independently associated with a higher risk of early readmission. |
format | Online Article Text |
id | pubmed-8069311 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-80693112021-04-26 Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine Martín-Sánchez, Rubén Ángel Lorenzo-Villalba, Noel Calvo-Elías, Alberto Elpidio Dubón-Peralta, Ester Emilia Chocrón-Benbunan, Cynthia Elisa Cano-de Luque, Carmen María López-García, Lidia Rivas-Molinero, María Outón-González, Cristina Marco-Martínez, Javier Calvo-Manuel, Elpidio Andres, Emmanuel Méndez-Bailón, Manuel Medicina (Kaunas) Article Background and objectives: Patients with heart failure (HF) often present with non-valvular atrial fibrillation and require oral anticoagulation with coumarin anticoagulants such as acenocoumarol. The objective of this study was to evaluate the relationship between time in therapeutic range (TTR) and the risk of early readmission. Materials and Methods: A retrospective descriptive study was carried out on hospitalized patients with a diagnosis of HF between 2014 and 2018 who had adverse effects due to oral anticoagulation with acenocoumarol (underdosing, overdosing, or hemorrhage). Clinical, analytical, therapeutic, and prognostic variables were collected. TTR is defined as the duration of time in which the patient’s International Normalized Ratio (INR) values were within a desired range. Early readmission was defined as readmission within 30 days after hospital discharge. Patients were divided into two groups depending on whether or not they had a TTR less than 60% (TTR < 60%) over the 6 months prior to the adverse event. Results: In the cohort of 304 patients, the mean age was 82 years, 59.9% of the patients were female, and 54.6% had a TTR < 60%. Patients with TTR < 60% had a higher HAS-BLED score (4.04 vs. 2.59; p < 0.001) and INR (6 vs. 5.31; p < 0.05) but lower hemoglobin (11.67 vs. 12.22 g/dL; p < 0.05). TTR < 60% was associated with early readmission after multivariate analysis (OR: 2.05 (CI 95%: 1.16–3.61)). They also had a higher percentage of hemorrhagic events and in-hospital mortality but without reaching statistical significance. Conclusions: Patients with HF and adverse events due to acenocoumarol often have poor INR control, which is independently associated with a higher risk of early readmission. MDPI 2021-04-09 /pmc/articles/PMC8069311/ /pubmed/33918627 http://dx.doi.org/10.3390/medicina57040365 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Martín-Sánchez, Rubén Ángel Lorenzo-Villalba, Noel Calvo-Elías, Alberto Elpidio Dubón-Peralta, Ester Emilia Chocrón-Benbunan, Cynthia Elisa Cano-de Luque, Carmen María López-García, Lidia Rivas-Molinero, María Outón-González, Cristina Marco-Martínez, Javier Calvo-Manuel, Elpidio Andres, Emmanuel Méndez-Bailón, Manuel Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine |
title | Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine |
title_full | Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine |
title_fullStr | Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine |
title_full_unstemmed | Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine |
title_short | Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine |
title_sort | clinical impact of the time in therapeutic range on early hospital readmission in patients with acute heart failure treated with oral anticoagulation in internal medicine |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069311/ https://www.ncbi.nlm.nih.gov/pubmed/33918627 http://dx.doi.org/10.3390/medicina57040365 |
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