Abstract
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.
Highlights
The incidence of heart failure (HF) is progressively increasing in daily clinical practice and is often associated with non-valvular atrial fibrillation [1] (NVAF), requiring anticoagulant treatment [2]
Direct-acting oral anticoagulants (DOACs) have emerged as therapeutic alternatives in NVAF as they overcome many of the inherent disadvantages of Vitamin K antagonists (VKAs)
23.16% of the patients were readmitted within 30 days after hospital discharge, and in-hospital mortality was 7.38%
Summary
The incidence of heart failure (HF) is progressively increasing in daily clinical practice and is often associated with non-valvular atrial fibrillation [1] (NVAF), requiring anticoagulant treatment [2]. The use of VKAs is still significantly more predominant than DOACs in Spain [3,4] even if it has been reported that approximately 40% of AF patients on VKA treatment have poor control of anticoagulation [5,6,7] This situation could result from the fact that the prescription of direct-acting anticoagulants in atrial fibrillation in Spain is subject to state funding through a pharmaceutical regulation. TTR < 60% was associated with early readmission after multivariate analysis (OR: 2.05 (CI 95%: 1.16–3.61)) They 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
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