Prediction Score for Anticoagulation Control Quality Among Older Adults

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Lynn B. Oertel¹  Suzanne Blackley²  Li Zhou³  Daniel E. Singer⁴  Gina Dube⁵  Sebastian Schneeweiss⁶  Kueiyu Joshua Lin⁶  Jun Liu⁶  Robert J. Glynn⁶ 

[1] Anticoagulation Management Service, Department of Nursing, Massachusetts General Hospital, Boston, MA;Clinical and Quality Analysis, Information Systems, Partners HealthCare System, Boston, MA;Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA;Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA;Department of Pharmacy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA;Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA;

关键词: anticoagulant;    atrial fibrillation;    quality control;    stroke;    venous thromboembolism;   

DOI  :  10.1161/JAHA.117.006814

来源: DOAJ

【 摘 要 】

BackgroundTime in the therapeutic range (TTR) is associated with the effectiveness and safety of vitamin K antagonist (VKA) therapy. To optimize prescribing of VKA, we aimed to develop and validate a prediction model for TTR in older adults taking VKA for nonvalvular atrial fibrillation and venous thromboembolism. Methods and ResultsThe study cohort comprised patients aged ≥65 years who were taking VKA for atrial fibrillation or venous thromboembolism and who were identified in the 2 US electronic health record databases linked with Medicare claims data from 2007 through 2014. With the predictors identified from a systematic review and clinical knowledge, we built a prediction model for TTR, using one electronic health record system as the training set and the other as the validation set. We compared the performance of the new models to that of a published prediction score for TTR, SAMe‐TT2R2. Based on 1663 patients in the training set and 1181 in the validation set, our optimized score included 42 variables and the simplified model included 7 variables, abbreviated as PROSPER (Pneumonia, Renal dysfunction, Oozing blood [prior bleeding], Staying in hospital ≥7 days, Pain medication use, no Enhanced [structured] anticoagulation services, Rx for antibiotics). The PROSPER score outperformed SAMe‐TT2R2 when predicting both TTR ≥70% (area under the receiver operating characteristic curve 0.67 versus 0.55) and the thromboembolic and bleeding outcomes (area under the receiver operating characteristic curve 0.62 versus 0.52). ConclusionsOur geriatric TTR score can be used as a clinical decision aid to select appropriate candidates to receive VKA therapy and as a research tool to address confounding and treatment effect heterogeneity by anticoagulation quality.

【 授权许可】

Unknown