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
<i>Background and objectives:</i> 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 therape...
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MDPI AG
2021-04-01
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Online Access: | https://www.mdpi.com/1648-9144/57/4/365 |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Rubén Ángel Martín-Sánchez Noel Lorenzo-Villalba Alberto Elpidio Calvo-Elías Ester Emilia Dubón-Peralta Cynthia Elisa Chocrón-Benbunan Carmen María Cano-de Luque Lidia López-García María Rivas-Molinero Cristina Outón-González Javier Marco-Martínez Elpidio Calvo-Manuel Emmanuel Andres Manuel Méndez-Bailón |
spellingShingle |
Rubén Ángel Martín-Sánchez Noel Lorenzo-Villalba Alberto Elpidio Calvo-Elías Ester Emilia Dubón-Peralta Cynthia Elisa Chocrón-Benbunan Carmen María Cano-de Luque Lidia López-García María Rivas-Molinero Cristina Outón-González Javier Marco-Martínez Elpidio Calvo-Manuel Emmanuel Andres Manuel Méndez-Bailón 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 Medicina heart failure non-valvular atrial fibrillation acenocoumarol time in therapeutic range readmission |
author_facet |
Rubén Ángel Martín-Sánchez Noel Lorenzo-Villalba Alberto Elpidio Calvo-Elías Ester Emilia Dubón-Peralta Cynthia Elisa Chocrón-Benbunan Carmen María Cano-de Luque Lidia López-García María Rivas-Molinero Cristina Outón-González Javier Marco-Martínez Elpidio Calvo-Manuel Emmanuel Andres Manuel Méndez-Bailón |
author_sort |
Rubén Ángel Martín-Sánchez |
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_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_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_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 |
publisher |
MDPI AG |
series |
Medicina |
issn |
1010-660X 1648-9144 |
publishDate |
2021-04-01 |
description |
<i>Background and objectives:</i> 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. <i>Materials and Methods:</i> 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. <i>Results:</i> 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; <i>p</i> < 0.001) and INR (6 vs. 5.31; <i>p</i> < 0.05) but lower hemoglobin (11.67 vs. 12.22 g/dL; <i>p</i> < 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. <i>Conclusions:</i> 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. |
topic |
heart failure non-valvular atrial fibrillation acenocoumarol time in therapeutic range readmission |
url |
https://www.mdpi.com/1648-9144/57/4/365 |
work_keys_str_mv |
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doaj-2f613c23d45442b9abe3b41c815d155a2021-04-09T23:01:36ZengMDPI AGMedicina1010-660X1648-91442021-04-015736536510.3390/medicina57040365Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal MedicineRubén Ángel Martín-Sánchez0Noel Lorenzo-Villalba1Alberto Elpidio Calvo-Elías2Ester Emilia Dubón-Peralta3Cynthia Elisa Chocrón-Benbunan4Carmen María Cano-de Luque5Lidia López-García6María Rivas-Molinero7Cristina Outón-González8Javier Marco-Martínez9Elpidio Calvo-Manuel10Emmanuel Andres11Manuel Méndez-Bailón12Internal Medicine Department, Hospital Universitario Clínico San Carlos, Departamento de Medicina Universidad Complutense, Insituto de Investigacion Hospital Clinico San Carlos, 28040 Madrid, SpainService de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67000 Strasbourg, FranceInternal Medicine Department, Hospital Universitario Clínico San Carlos, Departamento de Medicina Universidad Complutense, Insituto de Investigacion Hospital Clinico San Carlos, 28040 Madrid, SpainInternal Medicine Department, Hospital Universitario Clínico San Carlos, Departamento de Medicina Universidad Complutense, Insituto de Investigacion Hospital Clinico San Carlos, 28040 Madrid, SpainInternal Medicine Department, Hospital Universitario Clínico San Carlos, Departamento de Medicina Universidad Complutense, Insituto de Investigacion Hospital Clinico San Carlos, 28040 Madrid, SpainInternal Medicine Department, Hospital Universitario Clínico San Carlos, Departamento de Medicina Universidad Complutense, Insituto de Investigacion Hospital Clinico San Carlos, 28040 Madrid, SpainInternal Medicine Department, Hospital Universitario Clínico San Carlos, Departamento de Medicina Universidad Complutense, Insituto de Investigacion Hospital Clinico San Carlos, 28040 Madrid, SpainInternal Medicine Department, Hospital Universitario Clínico San Carlos, Departamento de Medicina Universidad Complutense, Insituto de Investigacion Hospital Clinico San Carlos, 28040 Madrid, SpainInternal Medicine Department, Hospital Universitario Clínico San Carlos, Departamento de Medicina Universidad Complutense, Insituto de Investigacion Hospital Clinico San Carlos, 28040 Madrid, SpainInternal Medicine Department, Hospital Universitario Clínico San Carlos, Departamento de Medicina Universidad Complutense, Insituto de Investigacion Hospital Clinico San Carlos, 28040 Madrid, SpainInternal Medicine Department, Hospital Universitario Clínico San Carlos, Departamento de Medicina Universidad Complutense, Insituto de Investigacion Hospital Clinico San Carlos, 28040 Madrid, SpainService de Médecine Interne, Diabète et Maladies Métaboliques, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67000 Strasbourg, FranceInternal Medicine Department, Hospital Universitario Clínico San Carlos, Departamento de Medicina Universidad Complutense, Insituto de Investigacion Hospital Clinico San Carlos, 28040 Madrid, Spain<i>Background and objectives:</i> 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. <i>Materials and Methods:</i> 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. <i>Results:</i> 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; <i>p</i> < 0.001) and INR (6 vs. 5.31; <i>p</i> < 0.05) but lower hemoglobin (11.67 vs. 12.22 g/dL; <i>p</i> < 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. <i>Conclusions:</i> 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.https://www.mdpi.com/1648-9144/57/4/365heart failurenon-valvular atrial fibrillationacenocoumaroltime in therapeutic rangereadmission |