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Quality of Clinical Documentation and Anticoagulation Control in Patients With Chronic Nonvalvular Atrial Fibrillation in Routine Medical Care

Department of Medicine, Boston University, Boston, MA, Jack.ansell{at}bmc.org

J. Jaime Caro, MD

Caro Research Institute, Montreal, PQ, Canada

Maribel Salas, MD

Caro Research Institute, Montreal, PQ, Canada

Rowena J. Dolor, MD

Duke Primary Care Research Consortium, Duke Clinical Research Institute, Durham, NC

William Corbett, MD

UMass Memorial Community Medical Group, Worcester, MA

Andrew Hudnut, MD

Sutter Institute for Medical Research, Sacramento, CA

Saleem Seyal, MD

Research Institute of Middle America, Jeffersonville, IN

Noreen D. Lordan, BSc

Caro Research Institute, Montreal, PQ, Canada

Irina Proskorovsky, BSc

Caro Research Institute, Montreal, PQ, Canada

Gail Wygant, RN, MS

AstraZeneca Pharmaceuticals LP, Wilmington, DE

Objective. Anticoagulation quality and record documentation were retrospectively assessed in patients with chronic nonvalvular atrial fibrillation (CNVAF) managed in a routine care setting. Methods. Medical record data extraction from physician practices in 4 regions of the United States. Results. Of 686 patients, 59% had an electrocardiogram confirming CNVAF, 84% listed at least 1 stroke risk factor, and 60% indicated the goal target international normalized ratio (INR). Two thirds of INRs >3.0 or <2.0 had no recorded dose change, nor did 45% of INRs >5.0. Vitamin K was given (3%) or anticoagulation was temporarily discontinued (9%) for INRs >5.0. The median interval of INR testing was 21 days, which decreased to 7 days for INRs > 4.60. Patients spent 58% of the time in therapeutic range. Conclusion. Serious deficiencies in quality and documentation of routine medical care of anticoagulation for patients with CNVAF continue to exist. (Am J Med Qual 2007;22:327-333)

Key Words: routine medical care • health care • anticoagulation • atrial fibrillation • vitamin K antagonists • INR

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